A Shared Health Service
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Forms

Account forms

  • Account and Access Request 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 the Service Desk on behalf of the Authorized Sponsor
  • Authentication Questions form
    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.
  • Private Clinic Change Form 
    To ensure eChart, eHealth Hub and other Shared Health services continue without interruption, please return the completed form two weeks prior to any changes in: 
    • Ownership or legal name
    • EMR vendor
    • Server/s or internet service provider
    • Moving a clinic to another location
  • 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 the Service Desk by email.
  • 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 the following services:

Request for Promotional Materials

To receive promotional materials, please fill out the Promotional Materials Order form and return it to the address, email or fax number on the bottom of the form.

Site application

To apply to have access to eChart Manitoba at your location, please:

Site requested audits

Requesting a privacy audit is now easier than ever. As of April 1, 2017, you can now submit your request electronically through Remedy, the  Service Desk’s electronic service management system.

This new request process applies to all electronic information systems, including eChart Manitoba.

  • What should be submitted in your Service Desk request?
    All we need is your contact information and the system(s) you need audited.
  • What about the details?
    Your Service Desk ticket will be directed to a Shared Health Privacy Analyst who will contact you to obtain additional details.

Shared Health is committed to protecting the privacy and confidentiality of the user or individual associated with the audit request, so never include:

  • information that would identify the user or an individual in your audit request;
  • sensitive circumstances associated with the audit request.

Source forms

If you have any questions about the content of any of the above forms, please contact us at echart@sharedhealthmb.ca.