Form Name

Description

Physician's First Report of Injury - C050E

Used for the first occasion that a provider provides medical aid and reporting in relation to a work-related accident. Refer to Creating Workers’ Compensation Board (WCB) first reports (Alberta).

OIS Physician's First Report of Injury - C050S

Used for the first occasion that an OIS physician provides medical aid and reporting in relation to a work-related accident. Creating Workers’ Compensation Board (WCB) first reports (Alberta).

Physician's Progress Report - C151

Used for follow-up visit reports of injury by physician after a C050E First Report of Injury was already submitted for the patient. Refer to Creating Workers’ Compensation Board (WCB) progress report (Alberta).

OIS Physician's Progress Report of Injury - C151S

Used for follow-up visit reports of injury by OIS physician after a C050S First Report of Injury was already submitted for the patient. Refer to Creating Workers’ Compensation Board (WCB) progress report (Alberta).

Medical Invoice Report - C568

Used by specialists for medical care and supplies invoices that require health service codes.

Medical Consultation Report - C568A

Used by specialists for medical care invoices that require consultation attachments or in-line text to be provided.

Medical Supplies Invoice - C569

Used for invoices for medical supplies that do not have health service codes.

Medical Invoice Correction - C570

Used for invoice corrections for previously submitted invoices. Refer to Creating Workers' Compensation Board (WCB) C570 medical invoice correction form (Alberta).

Worker Copy

Used to provide the patient with a printed copy of the claim form for his or her employer. The worker copy is a condensed version of the most recent first or progress report.