C050E Physician’s First Report of Injury
Once the C050E has been generated in the WCB rapid report window, complete each section.
Required fields have a red asterisk next to them.
Section 1: Employer details
Complete every field in this section regarding the employer. (Staff could fill this information in on behalf of the practitioner).
After this section is complete, click the next button or the next section from the list on the left.
Click save, then click next or select next section from the list on the left.
Section 2: Accident details
Select the applicable radio button, if developed over time, enter date of exam, if injury was immediate enter the date of the injury.
Describe the injury/condition in the text box.
Click save, then click next or select next section from the list on the left.
Staff could fill this information in on behalf of the practitioner.
Section 3: Injury Details
Complete each field as it relates to the patient.
*Note, double click in the diagnostic code field to search for a diagnostic code.
If the injury/condition is applicable to more than one part of the body, click ‘add new part of body’ to create a new row.
Click save, then click next or select next section from the list on the left.
Section 4: Treatment Details
Complete each field as it relates to the patient.
*Note, if yes is selected for narcotics/opioids prescribed, a new field will appear to identify the medication and dose.
If Consultations, referrals, or investigations are required, select the appropriate category in the drop down, adding rows to include multiple entries.
*Note, selecting the type “Other” requires the details field to be filled out.
*Note, certain types of investigations, for example ultrasound, will make the Expedite check box appear.
If needing WCB assistance, mark the applicable check box.
Click save, then click next or select next section from the list on the left.
Section 5: Return to Work Details
Depending on the radio buttons selected, additional required fields will appear.
Complete all fields as they appear.
Click save, then click next or select next section from the list on the left.
Section 6: Invoice
Complete the claim information using service codes and modifiers, click add row to insert multiple service codes.
*Note, if the WCB Business Cost Program option is enabled in Program Setup, the BCP01 service code will automatically be populated in the first line.
*Note, double click in the service code field to search for a service code.
Click save, then click next or select next section from the list on the left.
Section 7: Attachments
If attachments are required, select the appropriate radio button where the documents to be attached are located.
- If from the patient chart, the
attachments window will open, select from the list in the middle, and click
add. For multiple documents, highlight and click add for each one. Click save,
note that file size is a maximum of 2MB.
- If the attachment exists as a file that is
accessible on this computer, select the Files radio button, select an
attachment type, click Browse and locate the file to be attached. File
size is a maximum of 1 megabyte.
Click save, then click next or select next section from the list on the left.
Section 8: Other Information
If available, enter the claim number, and any additional comments that are relevant.
Click save.
Click the notes complete check box highlighted above to see the completed notes icon on the doctor view.
Click here to review submitting a WCB claim.
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