Health / All Categories

This medical (re)assessment/referral form identifies criteria for medical eligibility to the Home Oxygen Concentrator Program. This form is applicable to the public, home care clients, palliative care clients, referring practitioner, family physician, all regional health authorities and Shared Health. This form is enforced by Manitoba Health, Seniors and Active Living
Department/Crown:Health
Category:Health

This policy is applicable to all health authorities and provides direction regarding expectations for Health Authority policies and protocols related to Medical Assistance in Dying, congruent with Federal legislation.  This policy is enforced by Manitoba Health, Seniors and Active Living.  

Department/Crown:Health
This policy is a technical guide to the file layout for electronic submission of claims for services rendered by practitioners.  It describes the specifications that must be met by medical billing software to ensure that electronically submitted claims are received successfully by Manitoba Health, Seniors and Active Living. This policy is applicable all practitioners and their staff who are involved in the process of electronic billing of claims to Manitoba Health, Seniors and Active Living. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy pertains to Medical First Response.  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 is a return of service contract for medical students / residents participating in the Medical Students/Residents Financial Assistance Program - 1st, 2nd, 3rd or 4th Year Undergraduates program. The contract outlines the obligations of the parties, namely MHSAL, and the medical student/resident with respect to the program. 
Department/Crown:Health
This is a return of service contract for medical students / residents participating in the Medical Students/Residents Financial Assistance Program - Postgraduate Educational Assistance Option program. The contract outlines the obligations of the parties, namely MHSAL, and the medical student/resident with respect to the program. 
Department/Crown:Health
This is the online form used for applicants to the Medical Student/Resident Financial Assistance Program (MSRFAP) Educational Assistance Option during the July 1, 2016 - June 30, 2017 period. Applicants were required to provide MHSAL with their basic personal information, their education information, banking information and contact information for the purpose of registering in the MSRFAP - EAO program.
Department/Crown:Health
Category:Application

 This is a return of service contract for medical students / residents participating in the Medical Students/Residents Financial Assistance Program - Northern/Remote Family Medicine Residency Stream (NRFMRS) and International Medical Graduate (IMG Program Combined Agreement 2016). The contract outlines the obligations of the parties, namely MHSAL, the University of Manitoba and the medical student/resident with respect to the program.

Department/Crown:Health
This is a return of service contract for medical students / residents participating in the Medical Students/Residents Financial Assistance Program - Rural/Northern Initiative for 4th Year Medical Students (RNI-4) program. The contract outlines the obligations of the parties, namely MHSAL, the University of Manitoba and the medical student/resident with respect to the program.
Department/Crown:Health

This policy outlines the process for regions to obtain reimbursement of costs associated with the dispensing of medications for meningococcal post-exposure prophylaxis. 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 an application to the Selkirk Mental Health Centre to cover the cost of attending the Mental Health First Aid Workshop they provide by demonstrating an explanation how this education would help you provide assistance to someone you know that is struggling with mental health problems. This form is available to the general public and external agencies including the Regional Health Authorities of Manitoba. This form is enforced by Mental Health Commission of Canada and Selkirk Mental Health Centre.

Department/Crown:Health
Category:Health

This form for use to appeal the following other types of decisions:

  • decisions made by a regional health authority assessment panel regarding an application for personal care in a personal care home;
  • decisions related to a request for approval to operate a laboratory or a specimen collection centre or the conditions imposed on an approval, or the revocation of an approval;
  • decisions related to licenses to operate a personal care home or the suspension or cancellation of licences;  
  • decisions made under The Emergency Medical Response and Stretcher Transportation Act related to licenses to operate an emergency medical response system or stretcher transportation service or the suspension or cancellation of licenses.
This form is filled out by members of the public, health authorities, health care corporations, and regional health authorities. This form is processed by the Manitoba Health Appeal Board.
Department/Crown:Health
Categories:Health, Licence
This document provides a guide to the hearing process for the various types of appeals held by the Manitoba Health Appeal Board. This document applies to The Manitoba Health Appeal Board, and to all participants in hearings, including Manitoba Health, Seniors and Active Living, the public, regional health authorities, and health care organizations. This document is overseen by the Manitoba Health Appeal Board.
Department/Crown:Health
Category:Health

This document lists some examples of the type of information that may be

included in the written brief (argument) and evidence, which is to be filed before the Manitoba Health Appeal Board hearing. This document applies to members of the public, specifically appellants (persons or corporations who are appealing a decision) and their representatives. This document is overseen by the Manitoba Health Appeal Board.
Department/Crown:Health
Category:Health

This form is for use to appeal the following decisions related to Home Care services, if the matter cannot be resolved with the Home Care program:

  • an application for Home Care service is denied
  • disagreement with the type of service that has been approved
  • disagreement with the level of service that has been approved

This form is filled out by members of the public, specifically Manitobans who have applied for or are receiving Home Care. The form is processed by the Manitoba Health Appeal Board.

Department/Crown:Health
Category:Health

This form is for use to appeal decisions made by Manitoba Health, Seniors and Active Living regarding the assessed daily rate charged to individuals residing in long-term health care facilities (for example, hospitals, personal care homes).  This form is filled out by members of the public. This form is processed by the Manitoba Health Appeal Board.

Department/Crown:Health
Category:Health

This form is for use to appeal decisions made by Manitoba Health, Seniors and Active Living in relation to persons who are refused registration as an insured person or denied a benefit under The Health Services Insurance Act and regulations made under the Act (for example, out-of-province medical services, plastic surgery, travel subsidies).  This form is filled out by membersญญญญญญญญญญ the public. This form is processed by the Manitoba Health Appeal Board.

Department/Crown:Health
Categories:Benefits, Health
This document provides the procedures for preparing a written brief and evidence, and submitting these to the Manitoba Health Appeal Board.  This document applies to the public, regional health authorities, health care organizations, and Manitoba Health, Seniors and Active Living.  This document is overseen by the Manitoba Health Appeal Board.
Department/Crown:Health
Category:Health
This form is used to authorize another person to represent the appellant (the person or corporation making the appeal) on the appeal.  This person can be a lawyer or another individual (such as a family member or friend). This form is filled out by members of the public, or corporations. This form is processed by the Manitoba Health Appeal Board.
Department/Crown:Health
Category:Health
This brochure describes people's right to appeal to the Manitoba Health Appeal Board, and provides information on the appeal process, hearing procedures, and the types of appeals heard. This document applies to the public, and to corporations. The brochure is overseen by the Manitoba Health Appeal Board.
Department/Crown:Health
Category:Health

This guideline outlines the minimum standards for the operation of a MFSE in the area of food safety and sanitation and should be used as a supplement to The Food and Food Handling Establishments Regulation. This guide is applicable to all Mobile Food Service Establishments (not to push carts or mobile food units that return to a commissary each day) and must be approved and permitted by a Public Health Inspector prior to operating. Health, Seniors and Active Living enforces the guidelines.

Department/Crown:Health
Category:Health
This policy addresses case and contact identification and management and other related public health issues with respect to Mumps. 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 document is to be completed by an active My Health Team to submit their Service Plan. This form is applicable toญญญญญญญญญญญ members of an operational My Health Team including individuals from of private primary care clinics, community organizations, service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.

Department/Crown:Health
Category:Health

The purpose of this form is for a My Health Team to plan the second My Health priority (timely access and complex patients). This form is applicable toญญญญญญญญญญญ members of a My Health Team including individuals from private primary care clinics, Regional Health Authorities, community organizations and service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.

Department/Crown:Health
Category:Health
The purpose of this form is to confirm and document information about the My Health Team as first described in the Expression of Interest to ensure that it is ready to move to the service planning stage. This form is applicable toญญญญญญญญญญญ members of a new My Health Team including individuals from private primary care clinics, Regional Health Authorities, community organizations and service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.
Department/Crown:Health
Category:Health
The purpose of this form is to document an initial service plan the My Health Team. This form is applicable toญญญญญญญญญญญ members of a new My Health Team including individuals from private primary care clinics, Regional Health Authorities, community organizations and service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.
Department/Crown:Health
Category:Health

The purpose of this form is to document a service plan budget for the My Health Team. This form is applicable toญญญญญญญญญญญ members of a My Health Team including individuals from private primary care clinics, Regional Health Authorities, community organizations and service delivery organizations. Manitoba Health, Seniors and Active Living processes this form.

Department/Crown:Health
Category:Health

This policy is intended for use by Health Authorities and Health Corporations when they purchase, lease, accept by donation or otherwise acquire medical equipment that will result in increased operating or capital costs.

Last updated: July 11, 2023

Department/Crown:Health

This policy is intended for use by the Provincial Health Authority (PHA) for capital project specific planning and design management, control, monitoring, evaluation, quality assurance and oversight to the planning, design, tender and delivery of capital projects for the construction, expansion or major renovation of facilities within their scope.

Last updated: July 11, 2023

 
Department/Crown:Health

This form is used to list the next of kin for Selkirk Mental Health Centre patients. This form is available to Selkirk Mental Health Centre patients, patients' family and staff. This form is enforced by the Selkirk Mental Health Centre.

Department/Crown:Health

This policy manual sets the parameters of the Northern Patient Transportation Program (NPTP) for subsidizing medical transportation costs for qualifying Manitoba residents.  This policy is applicable to Regional Health Authorities and the public. This policy is enforced by Regional Health Authorities.

Department/Crown:Health
This policy provides clarification and information on approved compounds for Pain Management including PIN numbers for specific pain management compounds.   This policy is applicable to all community pharmacy providers 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 Tiered Biologics Reimbursement Policy in Manitoba.  This policy is applicable to all biologics prescribers.  This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This form is intended to notify Registration and Client Services staff of changes to existing registration files 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.

Department/Crown:Health
Category:Health

This form is used to notify personal care home residents and their families/representatives of the residential/authorized charge assessed by Manitoba Health, Seniors and Active Living.  The form is applicable to personal care home facilities and those residents applying for a reduced residential charge and theirfamilies/representatives.  The form is filled out by the personal carehome facility.

Department/Crown:Health
Category:Health
This form is used by Registered Nurses Extended Practice to request a billing number required for submission of electronic claims (for non-remunerative tracking purposes only) to Manitoba Health, Seniors and Active Living. This form is applicable to Registered Nurses Extended Practice licensed to practice in Manitoba. This form is processed by Manitoba Health Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy provides support to efforts related to the recruitment of nurses in Manitoba through the Nurses Recruitment and Retention Fund by authorizing the use of funding to reimburse nurses for certain authorized expenses related to relocating to Manitoba. The policy indicates rules of eligibility for reimbursement and the responsibilities of the parties. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This is a Funding Request form to be used by applicants seeking funding for an eligible specialty program or course under the NRRF Specialty Programs and Courses Funding policy. Applicants are required to provide detailed program or course information, a description of projected benefits, and details regarding projected expenses. The form is filled out by Manitoba nurses, and is processed by the Nurses Recruitment and Retention Fund Committee.

Department/Crown:Health

This online application is intended to allow report of changes of address on Manitoba Health cards by existing Manitoba Health card holders to the Registration and Client Services Department.

This form is applicable to members of the public.

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

Department/Crown:Health
Category:Health
The purpose of this guide is to ensure that all personal service facilities are appropriately assessed and meet all requirements for obtaining registration. The form is applicable to the members of the public. Health, Seniors and Active Living that process the form.
Department/Crown:Health
Category:Health

This policy authorizes the Director of Psychiatric Services (the Chief Provincial Psychiatrist) to issue an Order of Committeeship on any person he/she believes to have severe mental health problems or illnesses and therefore unable to manage his or her property or personal care. An Order of Committeeship appoints The Public Trustee of Manitoba as committee of the person's property and personal care to protect those with a mental health problem, illness or disorder through provisions in The Mental Health Act.

This policy is applicable to Manitobans over the age of majority determined or suspected of being incapable of dealing with their own affairs due to mental health problems, illnesses or disorders. This policy is enforced by the Department of Health, Seniors and Active Living.

This policy describes the requirements of the Othopaedic Shoes Program in Manitoba.  This policy is applicable to eligible residents under the age of 18 who require orthopaedic shoes as prescribed by a medical practitioner.  This policy is enforced by Manitoba Heatlh, Seniors and Active Living.

Department/Crown:Health
Category:Health

The Out of Province Transportation Subsidies Regulation permits reimbursement of transpotation costs in accordance with the regulation.

The purpose of the Out-of-Province Travel Subsidy Claim Form is to provide insured Manitoba residents, who have received the prior approval of Manitoba Health, Seniors and Active Living to receive medical care outside of Manitoba.

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

Department/Crown:Health
Category:Health
This form is intended to submit requests for enrollment in the Palliative Care Drug Access Program which covers 100% of cost of eligible medication without deductible.  This form is completed by physician and palliative care coordinator on behalf of and applicable to members of the public in end stages of life.  This form is processed by Manitoba Health, Seniors & Active Living.

Department/Crown:Health
Category:Health
This policy describes the requirements to request Exception Drug Status (Part 3) drugs. This policy is applicable to Manitoba Healthcare Professionals eligible to prescribe Exception Drug Status (Part 3) drugs. This policy is enforced by Manitoba Health, Seniors and Active Living. 
Department/Crown:Health
Category:Health
This form is required to be completed by users who no longer require access to the Patient Access Registry Tool. This form is applicable to all users of the Patient Access Registry Tool. This form is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health

This form is required to be completed by users that need access to the Patient Access Registry Tool to perform a service or an assigned duty in accordance with the Patient Access Data Submission policy. This form is applicable to all users of the Patient Access Registry Tool. This form is enforced by Manitoba Health.  

Department/Crown:Health
This policy requires Regional Health Authorities and service delivery organizations in Manitoba to ensure that surgeons and specialists collect and submit timely and accurate data on publicly funded medical and surgical services to the Patient Access Registry Tool. This policy is applicable to service deliver organizations and the Regional Health Authorities. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
This manual informs users how to use the Patient Access Registry Tool and the requirements for submitting information. This policy is applicable to all users that are required to submit to the Patient Access Registry Tool and includes staff working at service deliver organizations, the regional health authorities, and Manitoba Health, Seniors and Active Living. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health

This form is used as an account of Selkirk Mental Health Centre patient personal effects list to those who are competent to manage their personal possessions. 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

The purpose of this form is to gather data to inform discussions at Primary Care Capacity Planning meetings. This form applies to primary care staff within the Regional Health Authorities. Manitoba Health, Seniors and Active Living staff process this form.

Department/Crown:Health
Category:Health

The purpose of this form is to document a service plan budget for the My Health Team. This form is applicable toญญญญญญญญญญญ members of a My Health Team including individuals from private primary care clinics, Regional Health Authorities, community organizations and service delivery organizations. Manitoba Health, Seniors and Active Living processes 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 Pediculosis Capitis. 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 HCS 205.3 is applicable to all licensed personal care homes in Manitoba and provides guidelines to ensure nursing services are organized and available to meet residents' nursing care needs in accordance with guidelines approved by the Minister and consistent with professional standards of practice.  This policy is enforced by Manitoba Health Seniors and Active Living.
Department/Crown:Health
Category:Health

This policy is intended to assist NRRF in addressing issues of nursing supply by supporting the allocation of funding for a return of service program that is available to nurses who wish to practice in personal care homes. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This policy outlines the circumstances under which the cost of transportation is the responsibility of the personal care home resident or of the regional health authority. This policy is applicable to Manitoba Health, Seniors and Active Living, regional health authorities, and the public. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This policy outlines a consistent provincial approach to assessment, placement, and separation in Manitoba's personal care homes and the application process for waivers of residential requirements. This policy is applicable to Manitoba Health, Seniors and Active Living, regional health authorities, and the public. This policy is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This information manual is used by Manitoba Health, Seniors and Active Living to provide information on the residential charges rate determination process, rate reduction and review processes, appeal process and waiver process.  In addition, the information manual provides an overview of the residential charge policies applied by Manitoba Health, Seniors and Active Living.  The information manual is applicable to Manitoba Health, Seniors and Active Living, other departments within the Provincial government, the Regional Health Authorities, personal care home facilities, residents of personal care home facilities and their families/representatives and the general public.  The information manual is updated on an annual basis by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This form must be completed and submitted to the department by individuals that are seeking access to their personal health information that is maintained by the department. This form is applicable to all individuals seeking access to their personal health information. This form is processed by the branch that maintains the information being sought.
Department/Crown:Health
Categories:Application, Health
This form must be completed and submitted to the department by individuals that are seeking to request a correction to their personal health information that is maintained by the department. This form is applicable to all individuals seeking to request a correction to their personal health information. This form is processed by the branch that maintains the information that is the subject of the request.
Department/Crown:Health
Categories:Application, Health
The purpose of these guidelines is to preventing health hazards from occurring in personal health facilities. This guide is applicable to premises offering services (listed in Table 1) to assist operators and personal service workers in preventing health hazards from occurring. Health, Seniors and Active Living enforces the guidelines.
Department/Crown:Health
Category:Health
This form is intended to submit application for basic registration of personal services or new ownership or new construction or extensive remodelling of a personal service facility by owner or representative. This form is applicable to members of public. Health, Seniors and Active Living process this form.
Department/Crown:Health
Category:Health

This form is an application to obtain a land emergency medical response personnel licence in the province of Manitoba. This form is applicable to qualified individuals seeking a licence to practice as EMS personnel. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application for currently licenced land emergency medical response personnel to renew a land emergency medical response licence. This form is applicable to licensed land emergency medical response personnel. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application for members of the public with lived experience of mental health problems and illnesses, or substance use problems and addictions,  to apply to the Perspectives Provincial Mental Health and Addictions Advisory Network.

This form is applicable to any member of the public (person with lived experience, family member, caregiver) who wishes to participate as a citizen advisor for provincial mental health and addictions programming and policy.

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

Department/Crown:Health
Category:Application
This policy addresses case and contact identification and management and other related public health issues with respect to Pertussis/Parapertussis. 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 requests for enrolment in Pharmacare Program and determination of a deductible for eligible medication coverage.  This form is applicable to members of the public.  This form is processed by Manitoba Health, Seniors & Active Living.

Department/Crown:Health
Category:Health
This policy outlines the various steps and actions which are normally followed in audits and claims submitted to Manitoba Health.  This policy is applicable to all community pharmacy providers in Manitoba. This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This policy describes the requirements for submitting pharmacy claims to Manitoba Health, Seniors and Active Living.  This policy is applicable to Manitoba pharmacies who submit claims to Manitoba Health, Seniors and Active Living.  This policy is enforced by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This form is used by physicians to request a billing number required for submission of electronic claims to Manitoba Health, Seniors and Active Living. This form is applicable to physicians licensed to practice in Manitoba. 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 Plague. 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 compendium includes the global policies and procedures required for the Department of Health, Seniors and Active Living to comply with The Personal Health Information Act. This policy is applicable to all areas of the department. This policy is enforced by branch leads.  
Department/Crown:Health
Category:Health

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.

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.

Department/Crown:Health
Category:Health
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