Forms

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

You have the right to know who has viewed your information, see and receive a copy of your information in eChart Manitoba and to place a Disclosure Directive in eChart Manitoba.

eChart Manitoba Services 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.

The forms are available in alternate formats on request. Please contact eChart Manitoba
Email: [email protected] | Phone: 1-855-203-4528

All of the information displayed in eChart Manitoba originates from existing electronic systems, including laboratory systems, pharmacy systems, client registry and immunization systems. Corrections to the information, if required, need to be completed by those sources and resent to eChart Manitoba. eChart Manitoba can facilitate this process by helping to communicate potential issues with the source sending system. eChart Manitoba has no ability to independently modify information that has been sent into the system by another source (e.g. lab).

To request a correction to your personal health information in eChart Manitoba, speak to your health-care provider and/or call eChart Manitoba at (toll free) 1-855-203-4528 for more information on this process.