Forms

Note: The address to send completed forms to is now 1502 – 155 Carlton Street, Winnipeg, Mb, R3C 3H8

eChart Manitoba (eChart) displays information from connected electronic source systems. It has no ability to modify information sent by a source system (e.g., lab).

A correction to information, if required, must first be completed by the source system and then resent to eChart. eChart facilitates this process by notifying source systems of potential issues. To request a correction to your personal health information in eChart, speak to your health-care provider. You have the right to receive a copy of your eChart records, know who has viewed your information in eChart, and place a Disclosure Directive on your eChart record. When requesting a copy of your Personal Health Information, review the Information sheet for Manitobans to see what data may be requested.

eChart can provide you with the following services:

		Request a copy of your personal health information Fill out this form to see or receive a copy of your personal health information in eChart Manitoba.
		Request a record of user activity Fill out this form to receive a list of authorized health-care providers who have viewed your personal health information in eChart Manitoba.
		Disclosure Directive Fill out this form to request a Disclosure Directive be placed on your personal health information in eChart Manitoba.

eChart forms can be made available in alternate formats upon request. 
Email: [email protected] | Phone: 1-855-203-4528