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Workers' Compensation Board

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Doctor's Narrative Report - (EC-4NARR)


Narrative Attachment Requirements
- for initial report, include all requirements listed below
- for subsequent reports, include only facts and findings that are new or changed from your last report.

History of the injury/illness

  • Who provided you with the information about the injury/illness?
  • Describe where and how the injury/illness occurred
  • Describe the patient's injury/illness and identify specifically any affected body parts
  • Other treatment for the injury/illness including hospitalization or surgery
  • Patient's subjective complaints
  • Relevant medical history, incl. prior treatment for a similar work-related injury/illness

Objective Findings/Clinical Evaluation

  • Physical examination (describe all relevant findings)
  • Diagnostic procedure(s)/test(s) performed prior to the visit
  • Diagnostic procedure(s)/test(s) performed during the visit
  • Treatment rendered at time of exam, if any
  • Diagnosis/clinical assessments

Plan of Care

  • Proposed treatment and treatment goals (include type of treatment, frequency and anticipated duration of treatment)
  • Medications (prescription and over-the-counter drugs) prescribed for the injury/illness
  • Any work restrictions that may result from these medications
  • Diagnostic test(s) ordered
  • Referrals/Consultations requested
  • Assistive devices prescribed
  • Prognosis for recovery
  • Follow-up appointment(s)

Work Status

  • Can the patient return to usual work activities as indicated (A.11)?
  • Are there any work limitations? (If so, explain and quantify, including the anticipated duration of the limitations)
  • Describe discussions with the patient and employer regarding return to work with any applicable limitations

Impairment
(Comment only if patient has a temporary impairment as indicated in E.4)

  • Describe findings and explain how impairment percentage was determined

Attachment File Types Accepted for Web Submission:

  • Text files (.txt file extension)
  • MS Word files (.doc file extension)
  • Rich Text files (.rtf file extension)
  • Tiff files preferably with a resolution of 200 dpi (.tif or .tiff file extension)
  • JPEG files (.jpg file extension)
  • GIF files (.gif file extension)
  • BMP files (.bmp file extension)
  • PDF files (.pdf file extension)

Attachment File Types Accepted for XML Submission:

  • Text (included in XML file)
  • Tiff files with a resolution of 200 dpi (.tif or .tiff file extension)