Please note that the forms will be unavailable to email starting 5 p.m. on Friday, February 16 until 8 a.m. on Tuesday, February 20 for maintenance.

Disability and Health Supports Unit

Request and Justification Forms

The Disability and Health Supports Unit (DHSU) follows current partner program policies and legislation to determine eligibility for medical supply/equipment and diet requests. All requests must be completed by a health professional using the following forms:

Health professionals that may complete the forms are:
  • physicians,
  • registered dieticians,
  • registered physician assistants,
  • registered nurse practitioners,
  • licensed practical nurses,
  • registered nurses,
  • registered midwives,
  • occupational therapists,
  • physical therapists,
  • respiratory therapists, and
  • speech language therapists.

If you require a form to be mailed you, or if have any questions, please contact the DHSU at 204-945-2197 or by email at disandhealthsupports@gov.mb.ca.

For Health Professionals

Health professionals recommending disability or health-related supports for participants in one of the partner programs, may complete and submit the appropriate form:

If you have any questions, please contact staff at the DHSU at 204-945-2197 or 1-877-587-6224 (toll free).