Forms and Policies
Application to Manitoba Health Hepatitis C Assistance Program - Physician Form
| The form is used to apply to the Manitoba Hepatitis C Assistance Program and includes consent by the applicant to authorize the physician named on the form to disclose personal health information to Manitoba Health, Seniors and Active Living for the purposes of administering the Manitoba Hepatitis C Assistance Program. This form is completed by the applicant and applicant's physician. This form is processed by Manitoba Health, Seniors & Active Living. |