Health Information Data Request Form

Instructions

This form is to be completed when requesting data held by Manitoba Health including aggregate, de-identified (anonymous) data.

Filling out the form in MSWord: Using the tab or arrow keys, the cursor will advance to the next input field, with the document text being protected from inadvertent changes. Checkboxes may be checked by clicking with a mouse, using the space bar, or entering an 'x'.

Health Information Data Request Form

If you have questions or require further information regarding data content, please contact the appropriate Manitoba Health program area:

Health Information Management – Nathan.Hoeppner@gov.mb.ca; (204) 786-7261
Cadham Provincial Laboratory – Paul.VanCaeseele@gov.mb.ca; (204) 945-6456
Public Health – Patricia.Caetano@gov.mb.ca; (204) 788-6700