Health Information Data Request Form


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

Filling out the form in MS-Word:  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'.

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

If you require access to your own personal health information maintained by Manitoba Health, please follow the process outlined here.