Back/pain program application

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Please provide details about your back/pain program (If successful, these details will appear on WorkCover's internal directory.)

Program details

Practice details

Scope of practice *
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Facility *
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Support staff *
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How often do you run programs?

Team structure

Interdisciplinary *
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Multidisciplinary *
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Medical specialist involvement *
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Clinical coordinator role *
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Physiotherapist on staff *
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Occ therapist on staff *
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Exercise physiologist on staff *
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Psychologist on staff *
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Dietician on staff *
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Team skills

Each discipline well trained with special interest in back/pain *
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Professional development/mentoring offered regularly *
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> 1 year experience of staff *
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Selection of participants

Documented pre-screening process *
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Cross section of WorkCover and other participants in the one group *
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Group approach *
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Individual approach *
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Follow up

Assess outcome measures *
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Data collection and analysis *
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Post program follow up review *
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WorkCover service level standards

I hereby agree to the following WorkCover service level standards
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Alternatively, please email through attachment to michelle.maclean@workcoverqld.com.au

* Fields are compulsory, other fields are optional.