This form is to allow patients to suggest calming activities in advance of a crisis situation. This form is available to Selkirk Mental Health Centre patients and staff. This form is enforced by the Selkirk Mental Health Centre.

Department/Crown:Health

This policy is intended for use by Health Authorities to guide their process for purchasing, leasing or otherwise acquiring real property, or an interest in real property.

Last updated:  July 11, 2023

   
Department/Crown:Health

This form is used by Manitoba Health, Seniors and Active Living (the department) staff during a site visit to the addictions agencies which are supported in whole or in part by grants from the department. The form is completed by staff during the visit and outcomes reported to the Executive Director responsible.

This form is applicable toญญญญญญญญญญญ all Manitoba addictions agencies which receive grant funding through continuing service agreements with the department; agreement to submit to site visits by department staff is a condition of the agreements. The form is not public-facing.

This form will be processed by the department of Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

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.

Department/Crown:Health
Category:Health

This form is completed by Manitoba addictions agencies to provide detailed financial forecasting and quarterly reporting of their budget and expenditures.

This form is applicable toญญญญญญญญญญญ the Manitoba addictions agencies funded in whole or in part by grants from Manitoba Health, through continuing service agreements (service purchase agreements); this financial reporting is required as a condition of the agreements.

This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This form is used to track the movement of patients in personal care homes, whether through the admission of patients into personal care homes, the transfer of patients between personal care homes and the discharge of patients from personal care homes.  This form is applicable to Manitoba Health, Seniors and Active Living, the regional health authorities and personal care home facilities.  The form is filled out by staff at the personal care homes and processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is intended to submit admission/discharge information by Provincial and Federal jail facilities, Manitoba Development Centre and Selkirk Mental Health Centre to Manitoba Health to register or cancel provincial health coverage.

This form is for use only by staff of Registration and Client Services and Provincial/Federal Correctional, Manitoba Development Centre and Selkirk Mental Health Centre.

This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This form is used for obtaining permission and collecting relevant client immunization history before administering vaccine/s to an adult. This form is applicable to physicians, nurses, and other health professionals providing immunization services. This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form aids in remembering vaccines administered to adults. This form is applicable to adult recipients of vaccines. This form is NOT processed by Manitoba Health, Seniors and Active Living, and is for the sole use of the client.
Department/Crown:Health
Category:Health

The purpose of this document is to provide information on the Advanced Access training program. This document is applicable toญญญญญญญญญญญ primary care clinics considering taking the training. Manitoba Health, Seniors and Active Living owns and maintains this document.

Department/Crown:Health
Category:Health

This form is an application for currently licenced aeromedical attendant and aeromedical ambulance pilot personnel to renew there air emergency medical response licence. This form is applicable to licensed aeromedical attendant and aeromedical ambulance pilot personnel. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application to obtain an aeromedical ambulance pilot air emergency medical response licence in the province of Manitoba. This form is applicable to qualified individuals seeking the credential of aeromedical pilot. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application for currently licenced aeromedical ambulance pilot first officer licence to upgrade to an aeromedical ambulance pilot captain air emergency medical response licence. This form is applicable to licensed aeromedical ambulance pilot first officers. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This guide provides detailed instructions and information on what to do and who to call to help with flood recovery and restore a property to a healthy and safe condition. This guide is applicable to homes, businesses and building operators. Health, Seniors and Active Living provide the guide.
Department/Crown:Health
Category:Health

This is a legal agreement/contract for a My Health Team. It is applicable toญญญญญญญญญญญ Manitoba Health, Seniors and Active Living, Regional Health Authorities, and participating members from private primary care clinics, community organizations, service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.

Department/Crown:Health
Category:Health
This guide is developed to protect the health of the public by addressing air quality in arena facilities in Manitoba. The guide is applicable to ice-resurfacing equipment with fuel-burning (combustion) engines. Health, Seniors and Active Living prepare the document.
Department/Crown:Health
Category:Health

This form is an application for aviation companies to become licensed in the province of Manitoba so they can provide air emergency medical service. This form is applicable to business that wish to provide air emergency medical services. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This policy provides direction to standardize the process of collecting and reporting information on days spent in Selkirk Mental Health Centre as alternate level of care (ALC) following 180 days of voluntary admission. The policy applies to Selkirk Mental Health Centre clinical treatment teams. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This form is used as an agreement between the Government of Manitoba and the regional health authorities for the use of government provided ambulances. This form is applicable to regional health authorities in Manitoba. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an agreement between regional health authorities, licensed service providers, and the government of Manitoba over the use of government provided ambulances. This form is applicable licensed service providers who provide emergency medical services.  This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Amebiasis. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Anaplasmosis. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form is intended to submit report of routine inspection for permit registration or for change of ownership of a recreational water facility by owner or representative. This form is applicable to members of the public. Health, Seniors and Active Living process this form.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Anthrax. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
The 8 appendices outline technical requirements, standards and quality for the commercial prepackaged and non-prepackaged water guidelines. The guide applies to operators of water bottling plants or water vending machines including the types of facilities, the design, operations and maintenance in a sanitary manner in order to process and sell water for domestic purposes and to ensure that water does not become contaminated and pose a risk to Public Health. Health, Seniors and Active Living enforces the guidelines.
Department/Crown:Health
Category:Health

This is an individual education report template to be used by regional health authorities for the purpose of tracking program participation by individual nurses and the expenses incurred by each for the purposes of the continuing education program. The details are submitted to the Continuing Education Committee for the purpose of tracking program disbursements under the policy.

Department/Crown:Health

This is a group education report template to be used by regional health authorities for the purpose of tracking program participation by groups of nurses and the expenses incurred in relation to the continuing education program. The details, which include the number of attendees and expense details, are submitted to the Continuing Education Committee for the purpose of tracking program disbursements under the policy.

Department/Crown:Health

This is a group education detailed report template to be used by regional health authorities for the purpose of recording details of Non-Individual Continuing Education Activities that were delivered during an applicable reporting period. The details, which include various aspects including projected benefits of group education activities, are submitted to the Continuing Education Committee for the purpose of tracking activity under the policy.

Department/Crown:Health

This is a Continuing Education Committee (CEC) report checklist. It is to be used by CECs of regional health authorities for the purpose outlining details that must be provided to the Nurses Recruitment and Retention Fund (NRRF) for the purpose of satisfying reporting requirements under the policy. The details required include various elements such as committee memberships, funding, and individual/group education details, and they are to be submitted to NRRF for the purpose of tracking expenses and continuing education activity under the policy.

Department/Crown:Health

This form is used for long-term care assessment and application as part of the panelling process for long-term care, and for application to transfer from one facility to another.  The form can be used for personal care home placement, chronic care placement, supportive housing placement and companion care placement.  This form is applicable to Manitoba Health, Seniors and Active Living, the regional health authorities, personal care home facilities, and those patients applying for long-term care assessment and their families/representatives.  The form is filled out by the applicant for long-term care assessment or their representative, by the attending physician, by the nurse assessor, by the social assessor, by the case coordinator and by the assessment panel.  The form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This form is intended to be used for applying for benefits for the surgical removal of impacted teeth in cases where criteria for coverage under Division 3, Schedule C of the Hospital Services Insurance and Administration Regulation are satisfied. 

This form is applicable to Oral Surgeons. 

This form is processed by the Claims Unit, Insured Benefits, Insurance Division.

Department/Crown:Health
Category:Health
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.

Department/Crown:Health
Category:Health

This form is used to invoice Manitoba Health monthly, for services rendered on a sessional basis. 

This form is applicable to facilities that receive payment for services on a sessional basis. 

This form is processed by the Claims Unit, Insured Benefits, Insurance Division.

Department/Crown:Health
Category:Health

This form is used by personal care home facilities to determine and verify a resident's and their spouse's annual income, and by Manitoba Health, Seniors and Active Living to determine the resident's entitlement to a reduced residential/authorized charge.  This form is applicable to Manitoba Health, Seniors and Active Living, personal care home facilities and those residents applying for a reduced residential charge and their families/representatives.  The form is filled out by the personal care home resident or their representative and by the personal care home facility.  The form is processed by the personal care home facility and by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This checklist guides public health inspectors in conducting routine inspection recreational water facility for operations, safety and sanitation. This form is applicable to public health inspectors. Health, Seniors and Active Living process this form.
Department/Crown:Health
Category:Health
This guide is intended to increase safe recreational opportunities for patrons and the public by minimizing incidents in manmade lakes in Manitoba. This guide is applicable to public and organizations operating businesses on artificial lakes to reduce the risk of drowning and the risk of illness due to water quality issues. Health, Seniors and Active Living prepare the document.
Department/Crown:Health
Category:Health

This form is the Attending Physician Invoice template, for compensation of a physician providing evidence to the Mental Health Review Board on an individual coming before the Board in a hearing under The Mental Health Act.

This form is applicable toญญญญญญญญญญญ attending physician after a hearing or if they prepared and submitted a report but the hearing is cancelled. This form ensures compensation of the physician's time for preparation of the report, which is not compensated under Manitoba Health Insured Benefits.

This form is processed by the Department of Health, Seniors and Active Living.

This form, the Attending Physician Summary Template, is used when an issue (appeal or examination for Order of Committeeship) is under review at a hearing before the Mental Health Review Board. It is intended to simplify the attending physician's presentation at the hearing and to provide background information and health history on the patient under review at a hearing.

This form is applicable to the ญญญญญญญญattending physicians providing services/treatment to the individual patient under examination in a hearing before the Board.  

This form is processed by the Mental Health Review Board of the Department of Health, Seniors and Active Living, and a copy must be provided to the patient prior to the hearing.

This policy addresses case and contact identification and management and other related public health issues with respect to Babesiosis. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy establishes a program intended to promote the recruitment of bilingual nurses to work in a recognized bilingual/ francophone facility or program. Pursuant to the policy, the Nurses Recruitment and Retention Fund (NRRF) supports the allocation of funding to eligible RNs, RNs(EP), RPNs and LPNs in exchange for a return of service commitment by the individual applicant. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This policy addresses case identification and management and other related public health issues with respect to Blastomycosis. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Botulism. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form is used to assess the diagnostic certainty of adverse events following immunization using the Brighton Collaboration criteria. This form is applicable to physicians, nurses, pharmacists and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control.  This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Brucellosis. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This form is required as part of the submission requirements by manufacturers who are seeking public coverage for a Brand product in Manitoba.  This form is applicable to manufacturers who are requesting public coverage for new chemical entities, new combination products and drugs with new indications. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This guide provides minimum standards required for selling self-serve unwrapped bulk candies/ confectionery. The guide is applicable to bulk food self-service in the area of food safety and sanitation and in supplement to The Food and Food Handling Establishments Regulation. Health, Seniors and Active Living prepare the guide.
Department/Crown:Health
Category:Health
This guide provides standards for water hauling vehicles and associated equipment. The guide is applicable to operators of water hauling vehicles and applies to the design, operation and maintenance in a sanitary manner to prevent contamination and risk to public health. Health, Seniors and Active Living prepare the guide.
Department/Crown:Health
Category:Health
This form is used when there is no applicable tariff code listed in the Manitoba Physician's Manual for claiming medically required insured services.  Physicians use this form to describe the procedure or treatment performed, providing the necessary information to assess their claim, such as the size of the lesion, the area involved, complications, etc. This form is applicable to physicians claiming a by report tariff for services not listed in the Manitoba Physician's Manual. This form is processed by the Claims Unit, Insured Benefits, Insurance Division.
Department/Crown:Health
Category:Health

This form is used for requisition and specimen sample information provided to Cadham Provincial Labs from medical services providers. This form is available to all registered medical practitioners, midwives, hospitals, health units and other recognized health practitioners. This form is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is used for Retrovirus Nucleic Acid Testing requisition information provided to Cadham Provincial Labs from medical services providers. This form is available to all registered medical practitioners, midwives, hospitals, health units and other recognized health practitioners. This form is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This policy provides updated information on changes to the Cadham Provincial Laboratory Guide to Services. This update document is applicable to all health care providers who requisition laboratory testing from Cadham Provincial Laboratory. This policy is overseen by Cadham Provincial Laboratory.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Campylobacter Infection. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
The training provides standards for receiving, preparing and serving of food. The training is applicable to all food service personnel who are responsible for the receiving, preparing and serving of food in food service establishments to promote food hygiene. Health, Seniors and Active Living provides the training.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Chancroid. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form is used for obtaining permission and collecting relevant client immunization history before administering vaccine/s to a child. This form is applicable to physicians, nurses, and other health professionals providing immunization services. This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form aids in remembering vaccines administered to children. This form is applicable to children receiving vaccines or their parents or guardians. This form is NOT processed by Manitoba Health, Seniors and Active Living, and is for the sole use of the client.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Sexually-Transmitted Diseases in children. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This form is intended for the submission of claim requests for financial assistance for the  purchase of Hearing Aids.  This form is to be completed by the supplier and is applicable to members of the public under 18 years of age.  This form is processed by Manitoba Health.

Last updated May 24, 2023

Department/Crown:Health
Category:Health

This policy describes the requirements of the Children's Hearing Aid Program in Manitoba.  This policy is applicable to residents under the age of 18 who require a hearing aid as prescribed by an otolaryngologist or audiologist.  This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Chlamydia infection. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Cholera. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form is used to request an adjustment or correction on a processed claim for medical remuneration under the provincial health insurance plan.  This form applies to medical service providers and their billing staff that submit claims to Manitoba Health.  This form is processed by the Claim Unit, Insured Benefits, Insurance Division. 
Department/Crown:Health
Category:Health
This policy outlines the procedure to calculate the final price of an extemporaneous product (compound) that is either a benefit or non-benefit.  This policy is applicable to all community pharmacy providers that compound in Manitoba. This policy is enforced by Manitoba Health,, Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy describes the requirements of the Claims Submission Procedure for Methadone in Manitoba.  This policy is applicable to Manitoba pharmacies that dispense methadone.  This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This policy outlines the procedure to calculate the final price of an extemporaneous product (compound) that is either a benefit or non-benefit when the product is compounded by or procured from an Outsource Compounder.  This policy is applicable to all community pharmacy providers that outsource compounding in Manitoba. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This policy describes the submission procedure when submitting claims for extemporaneous products where the 1)number of minutes required to compound the product exceeds forty-five (45) minutes; or 2) Special Approval is required for coverage of non-benefit compound prescriptions.  This policy is applicable to Manitoba pharmacies.   This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This policy outlines the procedure when total claims as written by the prescriber exceed $9,999.99.  This policy is applicable to all community pharmacy providers that process claims exceeding $9,999.99 in Manitoba. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This policy describes the requirements of Claim Submission Procedure - Dispensing Frequency in Manitoba.  This policy is applicable to Manitoba pharmacies submitting claims for products listed on the Frequency of Dispensing List.  This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This form is required to report a suspected clinical case of a reportable disease or condition as required under the Reporting of Diseases and Conditions Regulation.    This form is applicable to health professional working in Manitoba. This form is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Clostridioides difficile Infection. This policy is applicable to physicians, nurses, and other health professionals working in public health, primary care, specialty care, community health and infection prevention and control. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy pertains to Code of Ethics. This policy is applicable to licensed paramedics and service providers. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This form is completed in the event of a cold chain failure involving publicly-funded vaccines and biologics. This form is applicable to physicians, nurses, pharmacists and other health professionals providing immunization services. This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy aims to assist immunization providers with the storage and handling of vaccines and biologics. This policy is applicable to physicians, nurses, pharmacists and other health professionals providing immunization services. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
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