- 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.
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:
- Access to your personal health information in eChart Manitoba
See or receive a copy of your personal health information in eChart Manitoba by filling out the Request to Access your Personal Health Information in eChart Manitoba form.
- Hide your personal health information in eChart Manitoba
Add or remove a disclosure directive to hide your personal health information in eChart Manitoba any time by filling out the Add or Remove a Disclosure Directive in eChart Manitoba form.
- See any activity on your personal health information in eChart Manitoba
Receive a copy of the health-care providers who have looked at your personal health information in eChart Manitoba by filling out the Provide Record of User Activity in eChart Manitoba form.
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.
To apply to have access to eChart Manitoba at your location, please:
- Fill in the appropriate fields in the eChart Manitoba Site Intake form.
- Send the completed form to the address, email or fax number on the bottom of the form.
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.
If you have any questions about the content of any of the above forms, please contact us at email@example.com.