This form is designed to provide detailed reporting from Manitoba addictions treatment agencies on the patient population entering their facility. Indicators include intake, referral point, income status, Indigenous status, geographic origin and primary and secondary substances.
This form is applicable to the Manitoba addictions agency supported in full or in part by grants from Manitoba Health, Seniors and Active Living. Requirements to provide this report and others are detailed in the continuing service agreements with the agencies.
This form is processed by the Department of Health, Seniors and Active Living.