• Direct Deposit Request for Medical Provider/Vendor/Clinic - C894 (pdf, 31KB)
• Home Assistance - Short term - C1138 (pdf, 69KB)
• Invoice Correction - C845 (pdf, 69KB)
• Invoice Correction - C845 (fillable, 65KB)
• Inventory Tracking - C915 (fillable, 60KB)
• Inventory Tracking - C915 (pdf, 54KB)
• Medical Services Reassessment - C570 (pdf, 50KB)
• Pharmacy Prescription Invoice - C774 (pdf, 92KB)
• Quote for Medical Equipment or Services (pdf, 232KB)
• Reason Codes (pdf, 48KB)
• WCB Billing number - C724 (Physicians only) (pdf, 38KB)

• Acupuncture Reporting Guide (pdf, 21KB)
• Acupuncture First Report - M007 (pdf, 21KB)
• Acupuncture Progress / Discharge Report - M007A (pdf, 12KB)
• Acupuncture Invoice - M007B (pdf, 11KB)
  
  
• Become an authorized Acupuncture Provider (pdf, 34KB)

• Authorized providers (pdf, 12KB)

• 2011-2014 Chiropractic Contract - Understanding your contract  (pdf, 58KB)
• Chiropractor joining an authorized clinic (pdf, 12KB)
• Relocating an WCB authorized chiropractic clinic (pdf, 21KB)
• Transfer in ownership of an authorized chiropractic clinic (pdf, 21KB)
• How to interpret your chiropractic performance report (pdf, 28KB)
• Sundry service codes and fees (pdf, 11KB)

• Become an authorized Chiropractor Provider (pdf, 34KB)
• Guidelines for non-authorized chiropractic providers (pdf, 19KB)
• Chiropractor's First Report - C056 (pdf, 82KB)
• Chiropractor's Progress/Discharge Report - C352 (pdf, 55KB)
• Chiropractor's Invoice - C552 (pdf, 38KB)

Note: WCB-Alberta has adopted the current Alberta Blue Cross Dental Fee Guide for generalists and specialists.

Dentist

• 2013 WCB-Blue Cross General Practitioner Dental Fee Guide (pdf, 354KB)
• 2013 WCB-Blue Cross Specialist Dental Fee Guide (pdf, 417KB)
• 2012 WCB-Blue Cross General Practitioner Dental Fee Guide (pdf, 448KB)
• 2012 WCB-Blue Cross Specialist Dental Fee Guide (pdf, 508KB)
• Dental Report - C055/C887 (pdf, 39KB)
• Dental Guide - C616 (pdf, 147KB)

Denturist

• 2013 Denturist Fee Guide (pdf, 30KB)
• 2012 Denturist Fee Guide (pdf, 30KB)
• Denturist Guide - C617 (pdf, 141KB)
• Denturist Report - C884 (pdf, 59KB)

• Diagnostic providers (pdf, 16B)
• Authorized WCB Referral Source Agents (pdf, 31KB)

Contract Alerts

• October 2010 (pdf, 35KB)
• March 2010 (pdf, 30KB)
• August 2009 (pdf, 31KB)

Forms

• Hearing Loss Assessment - C662 (pdf, 37KB)
• Hearing Loss Authorization - C972 (pdf, 17KB)
• Hearing Program Invoice - C659 (pdf, 25KB)
• Travel Reimbursement - C660 (pdf, 20KB)
• Hearing Aid Purchase Agreement - C1042 (fillable, 70KB)

• Workers' noise induced hearing loss package (pdf, 103KB). This package includes the following forms:
  • Hearing Loss Information - C042 (pdf, 32KB)
  • Workers Employment Record - noise induced hearing loss - C131 (pdf, 32KB)
  • Employer’s Information Questionnaire - C139 (pdf, 19KB)

Other Resources

• Hearing protection posters This poster series was developed to help workers understand the cost of not using hearing loss protective equipment.
• Hearing Loss fact sheet (pdf, 284KB)

• Home Health Invoice - C641 (pdf, 29KB) Rates effective August 1, 2011
• Home Health Invoice - C641 (fillable, 161KB) Rates effective August 1, 2011

• Home Health Care Authorization - C727 (pdf, 21KB)
• Home Health Care Authorization - C727 (fillable, 100KB)
  
  
• Home Health Assessment Report - C642 (pdf, 22KB)
• Home Health Assessment Report - C642 (fillable, 109KB)
  
  
• Home Health Personal Care Plan - C729 (pdf, 29KB)
• Home Health Personal Care Plan - C729 (fillable, 205KB)
  
  
• Home Health Homemaking Plan - C728 (pdf, 24KB)
• Home Health Homemaking Plan - C728 (fillable, 142KB)
  
  
• Home Health Supply Form - C726 (pdf, 20KB)
• Home Health Supply Form - C726 (fillable, 115KB)
  
  
• Home Health Receipt of Services - HC430 (pdf, 19KB)
  Home Health Receipt of Services - HC430 (fillable, 113KB)
  
  
• Home Health Monthly Status Report - C643 (pdf, 20KB)
• Home Health Monthly Status Report - C643 (fillable, 89KB)
  
  
• Home Health Incident Report - C921 (pdf, 20KB)
• Home Health Incident Report - C921 (fillable, 91KB)

Reporting forms

• Hospital Hand Clinic Assessment Report - C829 (pdf, 64KB)
• Hospital Hand Clinic Progress/Discharge Status Report - C830/831 (pdf, 68KB)
• Hospital Occupational Therapy Assessment/Discharge/Progress Report - C826/827/828 (pdf, 64KB)
• Hospital Physical Therapy Assessment Report - C823 (pdf, 64KB)
• Hospital Physical Therapy Status/Discharge Report - C824/825 (pdf, 67KB)

Day surgery services

• Surgical Services Facility Fee Invoice - C646 (fillable MS Word doc, 75KB) 
  * Note: this form can be filled in online and then printed.

Surgical facilities

• Out Patient Hospital Account - C012 (pdf, 18KB)
• In Patient Hospital Account - C094 (pdf, 11KB)

• Pulmonary History Questionnaire - C013 (pdf, 27KB)
• Worker's Employment Record (Chemical Exposure) - C117 (pdf, 35KB)
• Dermatitis Questionnaire - C437 (pdf, 23KB)
• Cardiac Questionnaire - C684 (pdf, 23KB)

Forms

• Work Readiness Report - C783 (fillible, 134KB)
• Early Intervention Report - C578 (pdf, 20KB)
• Status Report - C581 (fillible, 138KB)
• Progressive Injury - Physician's Report - C582 (pdf, 90KB)
  
  
• Workers Report of Injury or Occupational Disease - C060 (pdf, 100KB)
• Employer’s Report of Injury or Occupational Disease form - C040 (pdf,195KB)
  
  
• Contract Reference Guide for Worker Satisfaction Survey HC-711 (pdf, 23KB)
• Worker Satisfaction Survey HC-710 (pdf, 29KB)
• Contract Reference Guide for Employer Satisfaction Survey HC-714 (pdf, 24KB)
• Employer Satisfaction Survey HC-713 (pdf, 28KB)

Other Resources

• OIS Provider List (pdf, 207KB)
• OIS employer sign-up (fillable doc)
  
  
• Employer OIS fact sheet (pdf, 248KB)
• Employer OIS guide (pdf, 380KB)
• Provincial Employer OIS report (pdf, 24KB)
• Fee Summary (pdf, 181KB)
• Worker OIS fact sheet (pdf, 221KB)
• Worker OIS guide (pdf, 356KB)

Posters

• Employer OIS poster (pdf, 443KB)
• Worker OIS poster (pdf, 529KB)
• My OIS Role in Return to Work (pdf, 2.19 MB)
• Why Should I Choose OIS? (pdf, 3.32 MB)

• New vehicle modification assessment report - C822 (pdf, 212KB)
• New vehicle modification assessment report - C822 (fillable, 567KB)
  
  
• New Vehicle Modification Contract Reference Guide - HC-172 (pdf, 24KB)
  
  
• Occupational Therapy Referral - C956 (pdf, 16KB)
• Occupational Therapy Referral - C956 (fillable, 76KB)
  
  
• Occupational Therapy Invoice - C950 (pdf, 25KB)
• Occupational Therapy Invoice - C950 (fillable, 187KB)
  
  
• Occupational Therapy Assessment Report - C961 (pdf, 25KB)
• Occupational Therapy Assessment Report - C961 (Word, 67KB)
  
  
• Occupational Therapy Assessment Report Contract Reference Guide - HC-404 (pdf, 18KB)
  

• Personal Care Allowance Assessment Report - C589 (pdf, 31KB)
• Personal Care Allowance Assessment Report - C589 (Word, 123KB)
  
  
• Personal Care Allowance Assessment Contract Reference Guide - HC403 (pdf, 83KB)
  
  
• Pre and post accident profile report - C977 (pdf, 49KB)
• Pre and post accident profile report - C977 (Word, 91KB)
  
  
• Pre and post accident profile consent - HC-693 (pdf, 16KB)
  

• Pre and post accident profile Contract Reference Guide - HC-397 (pdf, 43KB)
  
  
• Wheelchair Assessment Report - C960 (pdf, 39KB)
• Wheelchair Assessment Report - C960 (Word, 125KB)
  
  
• Wheelchair Assessment Report Contract Reference Guide - HC-109 (pdf, 29KB)

• On-site health centre report fact sheet (pdf, 169 KB)
• On-site health centre report C-709 (pdf, 33 KB)

• Medication management report - C914 (fillable, 102KB)
• Medication management report - C914 (pdf, 21KB)
  
  
• Opioid management fact sheet for health care providers (pdf, 254KB)
• Opioid management fact sheet for workers (pdf, 254KB)
• Opioid (Narcotics) Treatment Agreement form - C-913 (pdf, 28KB)
• Substance Abuse Assessment Checklist form - C-942 (pdf, 21KB)
• Messages for patients taking opioids (pdf, 23KB)
• Canadian Opioid Guideline
• Opioid (narcotics) policy (Policy 04-06)
  
  
• MD Scope article (pdf,39 KB)

See Opioid Manangement page

Generic Oxycontin Position

• Notification to Alberta pharmacies on Generic Oxycontin prescription coverage (pdf, 35KB)

Service Contract Alerts

• Opioid Alert Mar 2013 (pdf, 44KB)

Pharmacy forms

• Pharmacy Prescription Invoice C774 (pdf, 35KB)

• Reference Guide to understanding your contract (pdf, 97KB)
• Physical Therapy Sundry List with Service Codes (pdf, 11KB)
• Physical Therapy Fee Guide (pdf, 23KB)
• Physical Therapy Clinic Authorization to Release Medical Information - C773 (pdf, 55KB)
• Relocating an WCB authorized physical therapy (pdf, 21KB)
• Transfer in ownership of an authorized physical therapy clinic (pdf, 21KB)
• On-site Physical Therapy Decision Tree (pdf, 21KB)

• Become an authorized Physical Therapy provider (pdf, 51KB)
• Physical Therapy Invoice - C019 (pdf, 19KB)
• Physical Therapy Completion Guide - C510 (pdf, 232KB)
• Physical Therapy Assessment Report - C533 (pdf, 47KB)
• Physical Therapy Status/Discharge - C534/C535 (pdf, 54KB)
• Disclosure of medical information to WCB-Alberta (pdf, 37KB)

• WCB fee schedule - Alberta physicians (pdf, 65KB)
  
• WCB fee schedule - Alberta Orthopedics (pdf, 49KB)
• Physician's Invoice & Report - C050, C151, C252
  *Note: only available through electronic injury reporting
• Physician's Reference Guide (pdf, 1.11 MB)
• Medical Care Invoice - C568 (pdf, 65KB)
  *Note: All specialists should use this form when invoicing WCB.
• Medical Supplies Invoice - C569 (pdf, 8KB)
  *Note: The above report must be submitted online through electronic injury reporting
• Medical Services Re-assessment - C570 (pdf, 50KB)
• WCB Billing Number - C724 (pdf, 19KB)
• WCB Billing Rules and Fees (pdf, 310KB)

• Authorization and Consent for Psychological Services - C850 (pdf, 16KB)
• User Guide to Reporting: Psychological Services (pdf, 25KB)
  
  
• Final report - C853 (pdf, 30KB)
• Final report - C853 (fillable, 78KB)
  
  
• Initial report - C851 (pdf, 30KB)
• Initial report - C851 (fillable, 76KB)
  
  
• Progress report - C852 (pdf, 30KB)
• Progress report - C852 (fillable, 78KB)
  
  
• Psychology Services Invoice - C846 (pdf, 20KB)
• Psychology Services Invoice - C846 (fillable, 102KB)
  
  
• Psychology Worker Satisfaction Survey - HC428 (pdf, 30KB)
  
  
• Traumatic Psychological Injury (TPI) Program Information (pdf, 30KB)

Worker information

• Worker Notice (pdf, 9 KB)
• Worker Satisfaction Survey C731 (pdf, 31 KB)

• Prosthetic and Orthotic Authorized Providers (pdf, 18 KB)
• Prosthetic and Orthotic Provider Update (pdf, 89 KB)
• Prosthetic and Orthotic Fee Guide
• Prosthetic and Orthotic - Fee Guide Addition/Deletion Form - HC-302 (pdf, 63KB)
  
  
• Prosthetic and Orthotic Services Invoice - C537 (fillable doc, 147KB)
• Prosthetic and Orthotic Services Invoice - C537 (pdf, 43KB)
  
  
• Prosthetic and Orthotic Services Authorization Request - C998 (fillable, 99KB)
• Prosthetic and Orthotic Services Authorization Request - C998 (pdf, 21KB)
  
  
• Prosthetic and Orthotic Services Status - C999 (fillable, 97KB)
• Prosthetic and Orthotic Services Status - C999 (pdf, 31KB)
  
  
• Microprocessor Knee Prosthetist Assessment - C989 (fillable, 90KB)
• Microprocessor Knee Prosthetist Assessment- C989 (pdf, 29KB)
  
  
• Microprocessor Knee Assessment Prosthetic Fact Sheet - HC-425 (pdf, 48KB)
  
  
• Microprocessor Knee Prosthetist Fitting Summary - C991 (fillable, 91KB)
• Microprocessor Knee Prosthetist Fitting Summary - C991 (pdf, 30KB)

Fee Schedules

• Assessment Services (pdf, 158KB)
• Return to Work Programs (pdf,233 KB)
  • Provider Site Based Program
  • Work Site Based Program
  • Hybrid Program
• Shoulder Services (pdf, 63KB)
• Traumatic Psychological Injury Program (pdf,252 KB)
• Vocational Services (pdf,114 KB)

RTW Referral Form

• Return to Work Services Referral Form - FM733A (pdf, 114KB)

Contract Providers

• Authorized WCB Referral Source/Agents (pdf, 35KB)

• Interpretation Services Summary - C780 (pdf, 34KB)
• Interpretation Services Summary - C780 (fillable, 132KB)
  
  
• Interpretation & Translation Services referral form - C779 (pdf, 19KB)
• Interpretation & Translation Services referral form - C779 (fillable, 103KB)
  
  
• Interpretation & Translation Services Invoice - C778 (pdf, 26KB)
• Interpretation & Translation Services Invoice - C778 (fillable, 136KB)