This form is to facilitate the connection of Selkirk Mental Health Centre patients to appropriate and safe companion services. This form is available to Selkirk Mental Health Centre patients, patient's family, committee or treatment team. This form is enforced by the Selkirk Mental Health Centre.
This form is used for patients to provide written consent to receive acupuncture as part of their treatment at Selkirk Mental Health Centre. This form is available to Selkirk Mental Health Centre physiotherapist, patients and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to authorize Selkirk Mental Health Centre staff to utilize electroconvulsive therapy as part of the patients' treatment. This form is available to Selkirk Mental Health Centre patient and treatment team staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to give patient consent to complete a Fiberoptic Endoscopic Evaluation of Swallow procedure. This form is available to Selkirk Mental Health Centre patients and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to authorize Selkirk Mental Health Centre staff to place the patient in seclusion under the following circumstances: the patient is in danger of harming themselves or others, having troubles settling for the night, after receiving calming medication, or needing less stimulus to calm themselves. This form is available to Selkirk Mental Health Centre patients and treatment team staff members. This form is enforced by Selkirk Mental Health Centre and The Mental Health Act c.110 of Manitoba.
This form is used to give permission to the Selkirk Mental Health Centre staff to receive information on their patients. This form is available to Selkirk Mental Health Centre patient and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to authorize Selkirk Mental Health Centre staff to utilize a therapeutic device as part of the patients' treatment. This form is available to Selkirk Mental Health Centre patient and treatment team staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used for voluntary admittance for psychiatric examination, care and treatment within the Selkirk Mental Health Centre. This form is available to applicants wanting voluntary admittance to the Selkirk Mental Health Centre. This form is enforced by the Selkirk Mental Health Centre.
This form is used to authorize placement of a WanderGuard bracelet on a patient as part of their treatment at the Selkirk Mental Health Centre. This form is available to Selkirk Mental Health Centre patients and staff members. This form is enforced by Selkirk Mental Health Centre.
This form gives permission to Manitoba Health, Seniors and Active Living to use an artist's or photographer's creative work in printed and online publications of their Mental Health, Addictions, or Spiritual Health Care Strategies. This form has previously been used for the Rising to the Challenge Provincial Mental Health Strategy, the Reclaiming Hope: Manitoba's Youth Suicide Prevention Strategy, the Health and the Human Spirit Spiritual Health Care Strategy.
This form is applicable to any member of the public giving MHSAL permission to use their creative work.
This form is processed by Manitoba Health, Seniors and Active Living.
This form is used to give permission to the Selkirk Mental Health Centre staff to release information on their patients. This form is available to Selkirk Mental Health Centre patient and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to give permission to the Selkirk Mental Health Centre staff to take or to cause to be taken audio or video recordings of their patients. This form is available to Selkirk Mental Health Centre patient and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is used to request consent to take photographs of the Selkirk Mental Health Centre patient. This form is available to Selkirk Mental Health Centre chief executive officer, delegate and staff members. This form is enforced by Selkirk Mental Health Centre.
This form is for submission of completed continuing education credits required yearly for maintenance of land emergency medical personnel licences. This form is applicable to licensed land EMS personnel. This form is processed by Manitoba Health, Seniors and Active Living.
This policy is intended to assist the Nurses Recruitment and Retention Fund in addressing issues of nursing supply by supporting the allocation of funding for a continuing education program. The program is available to nurses who wish to pursue professional development opportunities. This policy is enforced by Manitoba Health, Seniors and Active Living.
This policy pertains to Controlled Substances. This policy is applicable to licensed paramedics and service providers. This policy is enforced by Manitoba Health, Seniors and Active Living.
This form is an application to write the national Canadian Organization of Paramedic Regulators Entry to Practice Examination. This form is applicable to new graduates of approved pre hospital education programs. This form is processed by Manitoba Health, Seniors and Active Living.
This form is used to report cases of COVID-19. This form is filled out by health providers working in Manitoba who are required to report on this disease to public health. This form is enforced by Manitoba Health.
This form is intended to submit declaration of global income to determine the Pharmacare deductible in circumstances where Canadian Revenue Agency cannot provide income information for the applicant or spouse. This form is applicable to members of the public who are new Canadian residents within the last two taxation years. This form is processed by Manitoba Health, Seniors & Active Living. |
This form is intended to submit requests for enrollment in Deductible Installment Payment Program for Pharmacare which allows deductible to be paid in monthly intalments through Manitoba Hydro. This form is applicable to members of the public. This form is processed by Manitoba Health, Seniors & Active Living. |
This form is a referral to the Dialectical Behaviour Therapy Program in adherence with set guidelines, which the Selkirk Mental Health Centre intake team reviews. This form is available to external agencies within the Regional Health Authorities of Manitoba. This form is enforced by Manitoba Health, Seniors and Active Living.
This form is an application for medical dispatch centers to become licensed in the province of Manitoba. This form is applicable to agencies that wish to provide dispatch services to licensed land or air emergency medical service providers. This form is processed by Manitoba Health, Seniors and Active Living.
This policy is intended for use by Health Authorities and outlines the approvals needed to sell, lease or otherwise dispose of real property in accordance with this policy.
Last updated: July 11, 2023
This form is intended to submit requests for new/changes to installation and connection by which pharmacy locations submit prescription medication claims to the Drug Programs Information Network. This form is completed by pharmacy ownership. This form is processed by Manitoba Health, Seniors & Active Living. |
This on-line form is intended to submit requests for access to Drug Programs Information Network. This on-line form is completed by facility Access Coordinators. This on-line form is processed by Manitoba Health, Seniors & Active Living. |
This policy (memo) is to enable Regional Health Authorities and Provincial health Services Organizations to uphold accessibility requirements as set out in Manitoba Human Rights Code, the Canadian Charter of Rights and Freedoms and other relevant legislation; Manitoba Health, Healthy Living and Seniors holds a Service Purchase Agreement with E-Quality communication Centre of Excellence. This policy (memo) is applicable to all Regional Health Authorities, Cancer Care Manitoba and Diagnostics Service Manitoba. This policy is enforced by Manitoba Health, Seniors and Active Living.
This manual provides information regarding the establishment of electronic billing. This includes information about the steps required; from purchasing equipment to researching available software vendors to securing the services of a service bureau to submit claims on behalf of the practitioner.This policy is applicable to all practitioners and their staff who will be submitting claims to Manitoba Health, Seniors and Active Living. This policy is enforced by Manitoba Health, Seniors and Active Living.
This policy is a technical user manual for all practitioners, outlining how to submit electronic claims for services rendered to Manitoba Health Seniors and Active Living.
This policy is applicable to all practitioners and their staff who submit claims to Manitoba Health, Seniors and Active Living.
This policy is enforced by Manitoba Health, Seniors and Active Living.This policy pertains to Emergency Vehicle Operations. This policy is applicable to licensed paramedics and service providers. This policy is enforced by Manitoba Health, Seniors and Active Living.
This is a Verification of Incomplete Service Agreement form to be used by individuals who did not complete their 12 month NRRF return of service commitment, but requested employer verification of employment for the purposes of receiving funding from NRRF under the bilingual/French recruitment nursing program.
This form is an application to write the Emergency Medical Responder Entry to Practice Exam. This form is applicable to new graduates of approved emergency medical responder courses. This form is processed by Manitoba Health, Seniors and Active Living.
This online e-form is intended for residents of Manitoba to notify Registration and Client Services staff of changes to registration information by persons covered by Manitoba Health.
This form is applicable to members of the public.
This form is processed by Manitoba Health, Seniors and Active Living.
This policy establishes baseline performance levels, tracks system performance over time and reveals performance trends for computed tomography scanners. This policy outlines the tests that are typically part of a quality control program for computed tomography scanners. This policy is applicable to all relevant computed tomography scanners and clinicians who use them. This policy is enforced by CancerCare Manitoba.
This policy establishes baseline performance levels, tracks system performance over time and reveals performance trends for equipment quality control for film-screen radiology. This policy outlines the tests that are typically part of a quality control program for film-screen radiography equipment. This policy is applicable to all relevant film-screen radiography equipment and clinicians who use them. This policy is enforced by CancerCare Manitoba.
This policy establishes baseline performance levels, tracks system performance over time and reveals performance trends for equipment quality control for fluoroscopy. This policy outlines the tests that are typically part of a quality control program for fluoroscopic (radioscopic) systems, including C-arms. This policy is applicable to all relevant fluoroscopy equipment and clinicians who use them. This policy is enforced by CancerCare Manitoba.
This policy provides instructions and directions on how to perform quality control for modality displays. This policy is applicable to all relevant modality displays and people who use them. This policy is enforced by CancerCare Manitoba.
This policy establishes baseline performance levels, tracks system performance over time and reveals performance trends for equipment quality control for primary displays imaging physics. This policy outlines the tests that are typically part of a quality control program for primary displays. This policy is applicable to all relevant primary displays imaging physics equipment and clinicians who use them. This policy is enforced by CancerCare Manitoba.
This policy establishes baseline performance levels, tracks system performance over time and reveals performance trends for equipment quality for digital radiography. This policy outlines the tests that are typically part of a quality control program for digital radiography equipment, including portables with a dedicated detector. This policy is applicable to all relevant digital radiography equipment and clinicians who use them. This policy is enforced by CancerCare Manitoba.
This online e-form is intended for registration of Manitoba Health benefits by new residents to Manitoba.
This form is applicable to members of the public.
This form is processed by Manitoba Health, Seniors and Active Living.
This form is to provide the results of Emergency Medical Responder Entry to Practice Exam to applicants. This form is applicable to members of the public who have written the Emergency Medical Responder examination. This form is processed by Manitoba Health, Seniors and Active Living.
This form is to give permission to be an exam patient actor for the Emergency Medical Services Personnel Licensing Examination. This form is applicable to members of the public. This form is processed by Manitoba Health, Seniors and Active Living.
This policy is for the administration of External Service Providers' Grant funding to ensure that External Service Providers provide consistent quality services for similar grants and programs, and use public monies directly for the purposes intended. This policy is applicable to Health Authorities (Regional Health Authorities, CancerCare Manitoba, Addictions Foundation of Manitoba, Diagnostic Services Manitoba, as well as other that may be established in furture years) and their External Service Providers. This policy is enforced by Manitoba Health, Seniors and Active Living.
This form is intended to submit claim requests for finance assistance on purchase of eyeglasses. This form is completed by supplier on behalf of, and applicable to, members of the public 65 years of age and older. This form is processed by Manitoba Health, Seniors & Active Living. |
This form ensures all reports include standardized data elements related to alleged abuse and neglect of patients for the purpose of: data collection, screening, file creation, storage and reporting. This form is applicable to the public, alleged victim(s), alleged abuser, family/committee, reporter, facility contact, The Protection for Persons in Care Office (PPCO) and the Minister of Health, Seniors and Active Living. Individuals and facilities under The Health Services Insurance Act fills out the report form. This form is submitted by the health care facilities/staff, patients and the public to and processed by The Protection for Persons in Care Office. |
This fact sheet describes the criteria under regulation for a business to obtain a stretcher transportation services licence in the province of Manitoba. This policy is applicable to business that wish to provide stretcher services. This policy is enforced by Manitoba Health, Seniors and Active Living.
This form is to ensure the transfer of personal health information via fax is secure and to the person it is directed to in accordance with the Personal Health Information Act. This form is applicable to Family Doctor Finder staff employed with the regional health authorities. Manitoba Health, Seniors and Active Living processes this form.
This six-part form is an application to the Office of the Chief Provincial Psychiatrist (Director of Psychiatry) to permit a patient, who has been involuntarily admitted, to leave the Manitoba psychiatric facility in which they are being treated for a temporary period, while continuing in required psychiatric treatment.
This form is applicable to patients involuntarily admitted to a psychiatric facility in Manitoba, their attending physician or psychiatrist, and the Mental Health Review Board.
This form is processed by the attending physician/psychiatrist and the Mental Health Review Board.
This four part form is required when an attending psychiatrist renews a person's involuntary status in a psychiatric hospital or facility in Manitoba.
This form is applicable to the attending physician(s) or psychiatrist(s).
This form is processed by the Mental Health Review Board to monitor for hearings which are scheduled if deemed necessary.
This form is intended to gather information on Proponent(s) submitting a Proposal to provide Services, to ensure they have read the Request for Proposal, and their acceptance that all statements and representations in the Proposal are true. This form is applicable to Proponents providing a Proposal for Services being requested in the Request for Proposal. This form is processed by Manitoba Health, Seniors and Active Living.
Policy
This policy is intended to enable the receipt of Proposals from qualified Proponents meeting the requirements contained in the Request for Proposals. This policy is applicable to Proponents providing a Proposal in answer to the services contained within the Request for Proposal. This policy is enforced by Manitoba Health, Seniors and Active Living.
Form
This form is intended to provide a statement about real, potential or perceived conflicts of interest of any entity that will provide the Services within the Request for Proposal, including all proposed subcontractors of the Proponent. This form is applicable to Proponents providing a Proposal for Services being requested in the Request for Proposal. This form is processed by Manitoba Health, Seniors and Active Living.
Policy
This policy is intended to enable the receipt of Proposals from qualified Proponents meeting the requirements contained in the Request for Proposals. This policy is applicable to Proponents providing a Proposal in answer to the services contained within the Request for Proposal. This policy is enforced by Manitoba Health, Seniors and Active Living.
Form
This form is intended to provide a total price quotation, of which must include all wages, benefits, employer remittances, taxes and all other amounts payable by the Proponent to its personnel and all administrative and support service costs (including travel costs, if any), equipment, supplies, overhead and other incidental costs involved in providing the Services. This form is applicable to Proponents providing a Proposal for Services being requested in the Request for Proposal. This form is processed by Manitoba Health, Seniors and Active Living.
Policy
This policy is intended to enable the receipt of Proposals from qualified Proponents meeting the requirements contained in the Request for Proposals. This policy is applicable to Proponents providing a Proposal in answer to the services contained within the Request for Proposal. This policy is enforced by Manitoba Health, Seniors and Active Living.
Form
This form is intended to provide certification that the Services requested in the Request for Proposal are going to be provided by a Canadian Indigenous Business or a Manitoba Indigenous Business. This form is applicable to Proponents providing a Proposal for Services being requested in the Request for Proposal. This form is processed by Manitoba Health, Seniors and Active Living.
Policy
This policy is intended to enable the receipt of Proposals from qualified Proponents meeting the requirements contained in the Request for Proposals. This policy is applicable to Proponents providing a Proposal in answer to the services contained within the Request for Proposal. This policy is enforced by Manitoba Health, Seniors and Active Living.
Form
This form is intended to provide certification that if the Services requested in the Request for Proposal are going to be provided by a Canadian Indigenous Business or Manitoba Indigenous Business, the Proponent will provide a list of all of the entities that will provide the Services, including the Proponent and any proposed subcontractors of the Proponent. This form is applicable to Proponents providing a Proposal for Services being requested in the Request for Proposal. This form is processed by Manitoba Health, Seniors and Active Living.
This form is required when requesting reimbursement for more than two (2) professional fees per 30-day period (or 28-day cycle) for drugs listed on the Frequency of Dispensing List. This form is applicable to community pharmacies in Manitoba. This form is processed by Manitoba Health, Seniors and Active Living. |
This is an internal document for public health that outlines the process to complete the Families First screen form. |