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Request to Access PHI

To receive a copy of your personal health information in eChart Manitoba, please:

  • Fill in the appropriate fields in the form below and sign at the bottom
  • Send the signed and completed form to the address or fax number at the top of page two

If you have questions regarding these requirements, please contact eChart Manitoba at 1-855-203-4528. All forms must be signed originals received by mail or fax. You may be required to pay a fee per printed page.

For additional eChart information:

Other eChart forms are available to:

Manitoba Health
To learn more about your personal health information rights, please visit:

Manitoba Ombudsman
If you want to learn about your right to make a complaint related to your request to access your personal health information, contact the Manitoba Ombudsman office at:

750-500 Portage Avenue
Winnipeg, Manitoba R3C 3X1
In Winnipeg phone: 204-982-9130
Or toll-free: 1-800-665-0531

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