Authorization to Release Information to Manitoba Hepatitis C Assistance Program
The form is used by applicants to the Manitoba Hepatitis C Assistance Program to authorize Canadian Blood Services to initiate a traceback on any blood/blood products received in Canada and release any and all information to the Manitoba Hepatitis C Assistance Program for the purpose of determining eligibility for compensation. This form is completed by the applicant. This form is processed by Manitoba Health, Seniors & Active Living. |
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Health