Report templates
Are you providing treatment to patients injured in a car crash? Here you’ll find the report templates that you will need as a health care provider to note your key findings and recommended care plan.
As of April 1, 2019, chiropractors, counsellors, kinesiologists, occupational therapists, physiotherapists and psychologists can attach and submit reports to ICBC directly through the Health Care Provider Invoicing and Reporting (HCPIR) application. Visit our Support and resources page for instructions on submitting invoices through HCPIR.
Physicians can access the report template via their Electronic Medical Record (EMR) solution, as several common EMR solutions have them embedded. However, if your EMR solution does not contain the embedded report templates, you can access them through the link below and complete them as either a fillable PDF or by hand. In either case, reports can be mailed or faxed to ICBC. The mailing information can be found on the last page of each report or under the physician page’s invoicing and reporting section.
Additional notes
- All existing requests for CL-19s sent to ICBC prior to April 1, 2019, remain in effect
- When a report request is received for patients with open claims, physicians can complete the GP Reassessment Medical Report below
- For patients with new claims, new report templates can be used in conjunction with the initial assessment. Reassessment reports can be completed if or when care becomes complicated or prolonged, if an updated care plan is required or if a referral to a Registered Care Advisor is made.
For more information, visit the invoicing and reporting page.
Important: obtaining patient consent
It is important to discuss with your patient the purpose of the reports and ensure that you have received their consent to share the report with ICBC, consistent with your information sharing guidelines. Please ensure reports and information are shared with ICBC only where patient consent has been granted.
Where patient consent has not been granted to share reports with ICBC, ICBC will send the Health Care Provider Report request letter (CL491) to the health care provider outlining applicable legislation that permits ICBC to obtain the report.
ICBC is not permitted to request any other reports, diagnostic test results, or clinical records without patient consent.
Acupuncturists and registered massage therapists may also be requested to submit clinical records.
- Patient consent considerations for physicians
- Patient consent considerations for other health care providers
Treatment extension requests
As of April 1, 2019, if additional treatments beyond those that have been pre-approved are recommended for a patient’s rehabilitation and recovery, a treatment extension request can be submitted to ICBC directly through the HCPIR application.
Report templates
For treatments administered on or after April 1, 2019, please use the applicable report template. To fill in and save a PDF, download and open in Adobe Reader (version 8 or higher).
How to fill out standard medical reports
Chiropractors
- CL489C – Chiropractic Initial Report
- CL489D – Chiropractic Reassessment Report (only completed upon request)
Counsellors
- CL489G – Counselling Initial Report
- CL489H – Counselling Reassessment Report (only completed upon request)
- Counsellor report completion guide
General Practitioners
- CL489 – Standard Medical Report
- How to fill out a standard medical report
- CL489A – GP Extended Medical Report
- CL489B – GP Reassessment Medical Report
Kinesiologists
- CL489J – Kinesiology Initial Report
- CL489K – Kinesiology Reassessment Report(only completed upon request)
Nurse Practitioners
Occupational therapists
- CL489L – Occupational Therapy Initial Report
- CL489M – Occupational Therapy Reassessment Report
- CL489N – Occupational Therapy Discharge Report
Physiotherapists
- CL489E – Physiotherapy Initial Report
- CL489F – Physiotherapy Reassessment Report(only completed upon request)
Psychologists
- CL489P – Psychology Initial Report
- CL489Q – Psychology Reassessment Report(only completed upon request)