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Please complete the form if you have been appointed Power of Attorney, substitute decision maker, committeeship or have a shared custody arrangement update.
What is the request type?
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Shared Custody
Power of Attorney
Committeeship
Substitute Decision Maker
First name as displayed on the Manitoba health card
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Last name as displayed on the Manitoba health card
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Registration number (six-digit alphanumeric)
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Personal Health Identification Number (PHIN - nine digits)
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Date of birth
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Email address
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Primary phone number
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