Manitoba's provincial drug programs cover Exception Drug Status drugs only when the patient meets the published EDS criteria, and this one-page form is the general request for EDS drugs without their own form. Prescribers use it for new requests and renewals. The EDS office triages each application by urgency, and approved coverage starts from the date the office received the request.
The prescriber, a physician or nurse practitioner, completes the whole form with their licence number rather than billing number, the patient's PHIN and Manitoba Health registration number, and signs it.
Download the current version from the source each time; forms change without notice.
Exception Drug Status (EDS) Request Form
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Manitoba's EDS processing notice sets triage targets from receipt of a complete application: 1 to 2 business days for urgent drugs such as antibiotics and anticoagulants, 3 to 5 for priority drugs such as cancer and palliative care medications, and 5 to 10 for chronic conditions such as osteoporosis.
It depends on the drug. Since October 2017, drugs on the EDS Indefinite Drug List need only initial approval, and coverage continues without reapplying. Drugs not on that list may still require renewal, which is why the form has New Request and Renewal checkboxes.
The prescriber's licence number, not their billing number; the form says so explicitly. It also asks for the patient's PHIN, Manitoba Health registration number and date of birth, and the requested medication's strength, dosage form, regimen and duration, along with the prescriber's address, phone and fax.