Treatment Plan Examples - ICBC

1 ICBC Treatment PlansTips and ExamplesMay 2021 Top tip: Be concise & use plain languageBelowis a list of the questions listed in the Treatment plan , for each question we have provided points on the type of information we are looking for in your What functional and symptom improvements have been made to date? Describe the client s objective and subjective improvements Illustrate how the injuries are changing over time and with Treatment Include outcome measures comparisons, if availableo( Neck Disability Index (NDI), Quick Disabilities of Arm, Shoulder & Hand (Quick DASH), Numeric Pain Rating Scale (NPRS), World Health Organization Disability Assessment Schedule (WHODAS) Q. Whatare the customer s current functional limitations? Describe the client s current limitations as they relate to pre-injury function Focus on objective findings pertaining to work/ activities of daily living (ADLs) when able Q. Whatfurther progress is anticipated with the proposed additional Treatment ?)

2 Describe the further anticipated functional improvements based on identified limitations What is the specific functional progress the Treatment is intended to achieve?Q. What is the intended outcome or functional goal? Describe the measureable goal the client is working to achieve What is the overall goal of Treatment ? Q. Are there any barriers that are delaying recovery? If so, please identify. Describe any relevant obstacles that are contributing to the client s current condition and recovery Indicate if there are relevant work place or personal factors affecting recovery (if necessary, elaborate in additional comments) Commentif recovery is progressing as expected Q. Is the client currently missing work/school? Select yes, if the customer is absent from work or schoolQ. Additional comments Any additional, relevant information to convey, including diagnosis (if applicable) This field is not mandatoryQ. Number of new recommended treatments to discharge Enter the number Q. Expected discharge date The date you anticipate that the customer will have completed treatmentExample 1:Acupuncture, Chiropractic, Kinesiology, Massage Therapy and PhysiotherapyThis example is based on actual Treatment Plans submitted to ICBC.

3 It is an additional resource to support health care providers when completing the Treatment plan and is meant to serve as a general guide Treatment PlansTips and ExamplesMay 2021Q. What functional and symptom improvement has been made to date? Pain and stiffness improving in neck and upper back (right side more painful than left) Desk work tolerance increased from 15 minutes to 2 hours. Active stretching, micro breaks and application of heat to control symptomsQ. Whatare the customer s current functional limitations? Prolonged sitting (4 hours) and computer work with repetitive mouse work Rest breaks required to perform household tasks after a full day of work to manage symptomsQ. Whatfurther progress is anticipated with the proposed additional Treatment ? Improved tolerance for desk work and computer work for 4 hours without the need for micro breaks Ability to fully engage in household tasks with minimal affect to neck and upper back painQ. What is the intended outcome or functional goal?

4 Maintain full work with minimal symptoms escalation Ability to manage residual symptom effectively using self management techniques Resumption of all non-work activitiesQ. Are there any barriers that are delaying recovery? If so, please identify. Concern re financial pressures and not being able to work or remain job attached Desk setup seems to increase symptoms Q. Is the client currently missing work/school? NoQ. Additional comments Recommend ergonomic assessmentQ. Number of new recommended treatments to discharge #Q. Expected discharge date dd/mmm/yyyyExample 2:Acupuncture, Chiropractic, Kinesiology, Massage Therapy and PhysiotherapyThis example is based on actual Treatment Plans submitted to ICBC. It is an additional resource to support health care providers when completing the Treatment plan and is meant to serve as a general guide Treatment PlansTips and ExamplesMay 2021Q. What functional and symptom improvement has been made to date? Improved lifting ability due to range of motion and strength in right shoulder Decreased pain due to core and postural stability General mobility-standing, walking Ability to go up/down stairs Q.

5 Whatare the customer s current functional limitations? General mobility (walking with cane in home, standing, manage stairs slow and with discomfort) activities of daily living (personal care) due to right shoulder pain Return to physical job due to mobility and shoulder limitationsQ. Whatfurther progress is anticipated with the proposed additional Treatment ? Improve standing and walking tolerance and managing stairs better Independent in ADLs without difficulty and discomfort in right shoulder Initiate graduated return to work planQ. What is the intended outcome or functional goal? Independence in ADLs Full return to work, starting to work at 2x week to help manage flare-ups as able, adjusting and revising exercise planQ. Are there any barriers that are delaying recovery? If so, please identify. Mobility and shoulder limitationsQ. Is the client currently missing work/school? YesQ. Additional comments Patient has been provided with exercises/stretches to manage flare-ups independentlyQ.

6 Number of new recommended treatments to discharge #Q. Expected discharge date dd/mmm/yyyyExample 3:Counselling and Psychology This example is based on actual Treatment Plans submitted to ICBC. It is an additional resource to support health care providers when completing the Treatment plan and is meant to serve as a general guide Treatment PlansTips and ExamplesMay 2021Q. What functional and symptom improvement has been made to date? More aware of their own anxiety affecting driving. Better awareness of stress management strategies Ability to drive for short distances while controlling anxiety Improvement in overall mood Reported mild improvement to focus on work tasksQ. Whatare the customer s current functional limitations? Unable to drive greater than 30 minutes on highway due to limited ability to control anxiety Impacts with work due to forgetfulness & inability to concentrateQ. Whatfurther progress is anticipated with the proposed additional Treatment ? Ability to drive on the highway while controlling anxiety Ability to re-engage in full work productivity Q.

7 What is the intended outcome or functional goal? Return to driving anytime/anywhere while controlling anxiety Return to pre-accident work status (hours & duties)Q. Are there any barriers that are delaying recovery? If so, please identify. Unsupportive employer Focused on MSK injury painQ. Is the client currently missing work/school? NoQ. Additional comments Discussed the use of anti-anxiety medication with his family physician and started last week and expected to increase in dosage weeklyQ. Number of new recommended treatments to discharge #Q. Expected discharge date dd/mmm/yyyy