What the C1399 is for
The Diagnostic and Treatment Consultation program gives a treating physician an orthopaedic opinion on an injured worker’s diagnosis and management, with the aim of supporting maximum recovery. It is a WCB-arranged consultation for a worker with a WCB claim, separate from an ordinary specialist referral through the Alberta Referral Directory. It is also different from a request for a WCB physician or an independent medical examination.
Who completes it
The worker’s treating physician completes and signs the referral. The worker doesn’t complete any part. Write the claim number on each page, since the form repeats it at the top of the later pages.
How to fill in the referral
Referring physician
Give your name, phone, fax and email, and tick whether you want a call from the consultant on the day of the appointment or the report only. Choose the call when the management decision depends on the discussion, for example whether to proceed to imaging or surgery.
Patient demographics
Enter the worker’s surname, first name, health number, sex, date of birth, WCB claim number and phone numbers. Give a preferred contact number the worker actually answers, so they can be reached about the appointment.
Clinical information
Describe the chief complaint and relevant history, including the mechanism of injury and the course since. List clinical findings from your examination, and investigations and interventions so far with dates and results. State the question you want answered: diagnosis, whether imaging is needed, whether conservative treatment should continue, or surgical candidacy.
Treatment and management plan
Describe current treatment, such as physiotherapy, medication and work status, and other physicians consulted. Record the date of the follow-up appointment you have booked to discuss the recommendations with the worker.
Common reasons it’s delayed
- No WCB claim number on the form.
- A vague request with no clinical question.
- Missing investigation results or dates.
- An outdated phone number for the worker.
- No follow-up appointment booked to act on the opinion.
Submitting and who pays
Fax the completed referral to WCB-Alberta at 780-498-7807. The consultation is arranged through WCB-Alberta on the worker’s claim, and the specialist’s report comes back to you.