This form is completed by a physical therapist to either request approval for continued physiotherapy treatment (Treatment Plan Request – PE 83D219) or report discharge from physiotherapy (Discharge Report – 83D222)

The report provides WorkSafeBC with updated information on the worker’s progress, functional abilities, and next steps in care.

Please ensure you complete all fields accurately before submitting. If you’re completing a Discharge Report, you’re not required to complete the Treatment Goals or Request Summary sections.

All other applicable sections must still be completed to reflect the worker’s outcomes and status.

Need help completing this form?

1. Download the Physiotherapy Reference Manual.
2. See Appendix C for the Physiotherapy Treatment Report How To and Best Practices guide.

How to submit your form
To submit your form to us, download the form, digitally complete it, save it, and upload it by selecting the Upload form button.