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Send wsib form 26 pdf via email, link, or fax. You can also download it, export it or print it out.
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Click ‘Get Form’ to open the wsib form 26 in the editor.
Begin by entering the Claim Number and Date of Incident in the designated fields. Ensure all information is accurate and complete.
Fill in the Worker’s name, then proceed to the Return to Work Information section. Indicate if the worker can resume regular or modified duties, including start dates.
Specify if graduated hours are required and provide details on any other medical restrictions affecting the worker's return to work.
In the Functional Abilities section, check off whether the worker has full or some functional abilities. Mark each ability as 'Able to' or 'Not Able to' based on their condition.
Complete the Clinical Information and Treatment Plan section by indicating changes in the patient's condition since their last visit and current diagnosis.
Finally, fill out the Billing Section with service codes, health professional designation, and billing amounts as applicable before saving your completed form.
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