HCAI - Patient Management Program
Part 4
Signature of Health Practitioner
Complete the Signature of Health Practitioner information. Only practitioners listed below are permitted
to completion this section:
Chiropractor
Family / General Practitioner
Occupational Therapist
Optometrist
Physiotherapist
Psychologist
Pathologist
Dentist
Nurse Practitioner
Ophthalmologist
Other Medical / Surgical Practitioner
Psychiatrist
Speech-Language
The signature on file and signature date boxes are required fields when sending forms electronically.
Signatures are not transmitted to the insurer; however, hard copies of the form must be printed and
signed and kept on file. To obtain signatures, the entire OCF should be completed. It is not advisable for
health professionals or claimants to sign incomplete forms.
Print the completed draft form and have the Health Practitioner sign it.
Part 5
Injury and Sequelae Information
A large selection of commonly used codes have been incorporated into PMP however due to the size of
the full code list, not all are included. Item number 4 below details how to use a code not found in the
PMP list.
To access codes select the browse button to the right of ICD-10 Injury Code.
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