Forms
User Account forms
- User Account form
Fill out the Account and Access Request form to add, modify or disable eChart Manitoba user accounts. The Authorized Sponsor must approve each user and their access role. The Authorized Account Requestor may complete and submit the form to [email protected] on behalf of the Authorized Sponsor - Authentication Questions form (please right-click on the link and select ‘save link as…’ to download the form and open in Adobe Acrobat)
Have each user fill out the Authentication Questions form. This form is required for the Service Desk staff to validate the identity of the caller if they call for assistance or password changes for eChart. - Site Contacts Update form
Fill out the eChart Manitoba Site Contacts Update Form when the request involves any changes to site contacts. The form can be submitted to [email protected]. - Terms of Use form
All users of eChart must agree to the eChart Manitoba Terms of Use on their first log in to the system.
Personal Health Information forms
Manitobans have the right to know who has viewed their information, see and receive a copy of their information in eChart Manitoba and to hide their information from the view of anyone using eChart Manitoba. eChart Manitoba Services provides Manitobans forms to make a request for these services.
Request for Promotional Materials
To receive promotional materials, please fill out the request for promotional materials.
Site forms
To apply to have access to eChart Manitoba at your location, please:
- Fill in the appropriate fields in the eChart Manitoba Site Intake form.
To reduce the risk of interruptions to Shared Health services (e.g., eChart and eHealth_hub, etc.) submit the completed Private Clinic Change form, four (4) weeks prior to changes in:
- Ownership or legal name
- EMR vendor
- Internet service provider
- Moving a clinic to another location
Source forms
If you have any questions about the content of any of the above forms, please contact us at [email protected].