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Click ‘Get Form’ to open the AB-4 form in the editor.
Begin with Part 1: Claimant Information. Fill in your last name, first name, and middle name(s). Provide your mailing address, city, province, country, and postal code. Include your home, work, and cell phone numbers along with your email address and date of birth.
In Part 2: Primary Health Care Practitioner Information, enter the full name and profession of your primary health care practitioner. Complete their mailing address and contact details.
Proceed to Part 3: Primary Health Care Practitioner Feedback. Document the diagnosis at initial assessment and any key findings from the last visit. Set functional goals and indicate progress towards these goals.
For Part 4: Treatment Summary, record the total number of treatments along with dates for the first and last visits.
In Parts 5 and 6: Reason for Discharge or Need for Ongoing Treatment and Discharge Status, select appropriate options regarding recovery status and employment situation.
Finally, complete Part 7 by having your primary health care practitioner sign and date the form before submission.

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