Health Information Data Request Form
This form can be completed when requesting administrative data held by Manitoba Health, Seniors and Active Living (MHSAL) including aggregate, de-identified (anonymized) data. This form is applicable to the public or other Trustees. This form is enforced by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Categories:Application, Health
HIPC: Request for Access to Personal Health Information Held by the Government of Manitoba

This form is required when requesting access to personal health information maintained by a government department or agency for research in accordance to section 24 of The Personal Health Information Act. This form is applicable to researchers seeking to use personal health information maintained by the government or a government agency.  This form is enforced by The Health Information Privacy Committee.

Department/Crown:Health
Categories:Application, Health
In-Home Respite - Guide for Parents
This document informs parents about in-home respite for a child receiving support through Children's disABILITY Services. The guide is accompanied by a form requesting descriptive information about a child's care, routines and activity interests, behavioural issues, to be completed by parents and the direct service provider.
Department/Crown:Families
Categories:Application, Families
Initiate Home Clinic Registration Form

The purpose of this form is for primary care clinics to complete an application to become a Home Clinic. This form applies to all eligible private primary care clinics as well as Regional Health Authority operated primary care clinics. Digital Health, part of Shared Health Manitoba, processes this form.

Department/Crown:Health
Categories:Application, Health
Knowledge of Regulation Certificate

Confirmation of review and understanding of the design and installation requirements for onsite wastewater management systems as specified in the Manitoba Onsite Wastewater Management Systems Regulation MR 83/2003 and the Supplementary Information Manual (2010) and knowledge about the responsibilities a Certified Installer holds in the province of Manitoba.

Department/Crown:Environment and Climate
Categories:Application, Certification
Letter of Certification: Schedule B Assurance of Coordination of Professional Field Reviews

A form used to report that based on the designs, reviews of construction, and required certificates submitted under seal by all registered professionals on the project, and if applicable, ones own further reviews and/or any further statements issued to them under seal of professionals that the project meets the stated requirements.

Department/Crown:Consumer Protection and Government Services
Categories:Application, Certification, Housing and Property
Manitoba Health External Access Coordinators

This form is intended to manage the user access process by departments or facilities that access Manitoba Health's information systems. This form is applicable to all regional health authorities, CancerCare Manitoba, the Addictions Foundation of Manitoba, Selkirk Mental Health Centre and other publicly funded health care agencies/organizations requesting/requiring user access. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Categories:Application, Health, Healthy Living
Medical Release and Reference Information
To become a foster home under the Foster Home Licensing Regulations, the perspective foster parent must  submit information as to the applicant's physical and mental health being a medical reference from a medical practitioner or another health care provider or information obtained through a process approved by the mandating authority. This is the form used.
Department/Crown:Families
Categories:Application, Families
Medical Student/Resident Financial Assistance Program (MSRFAP) Application for the Eductional Assistance Option July 1, 2016 - June 30, 2017 - Online
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
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