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:
- Medical Supply Request and Justification Form (PDF 170KB)
- Medical Equipment Request and Justification Form (PDF 252KB)
- Therapeutic Diet and Nutrition Supplement Request and Justification Form (PDF 176KB)
- Wheelchair Seating Component Request and Justification Form (PDF 411KB)
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.
Contact
If you require a form to be mailed you, or if you have any questions, please contact us.
Alternate Format Requests
For alternate format requests, please contact the Department of Families Accessibility Coordinator:
Department of Families
Accessibility Coordinator
205 - 114 Garry Street
Winnipeg, MB R3C 4V4
Phone: 204-945-3744
Email: fswebunit@gov.mb.ca
For general inquiries contact Manitoba Inquiry
