All 34 verified Manitoba forms: WCB Manitoba reports, MPI driver fitness and PIPP therapy forms, Pharmacare EDS requests, disability supports, student aid and parking.
Manitoba has 34 verified forms in this library. WCB Manitoba accounts for 12, led by the Doctor First Report and Doctor Progress Report. MPI covers injury claims under PIPP, with chiropractic and therapy reports, and driver fitness, including the Medical Examination Report (MG-3979) and the mandatory Report to Registrar of Motor Vehicles (MCA-Form-157-2021). Drug coverage runs through Pharmacare's Exception Drug Status (EDS) Request Form and 33 drug-specific EDS forms.
Employment and Income Assistance and disABILITY services clients get equipment, supplies and therapeutic diets through Disability and Health Supports Unit request forms. Students use Manitoba Student Aid's Verification of Disability Form, also in French. MPI driver medicals aren't covered by Manitoba Health, so the individual pays. The provider, not the patient, starts the Manitoba Possible parking permit application. Vero Documents fills PDF forms from the visit note and chart, then you review and sign. Federal forms (T2201, CPP disability, EI) apply in Manitoba too and are on the federal hub.
Premier rapport du médecin
Physician's first report on a worker's workplace injury, including fitness for modified work and restrictions.
Athletic therapist's initial and progress/discharge reports, submitted online.
Rapport du dentiste
Dentist's report of a work-related dental injury: treatment to date, tooth chart, proposed treatment and estimate, plus a declaration.
Rapport du médecin sur l’évolution du patient
Physician's progress/discharge report on a worker's recovery and return-to-work capacity.
Entente de traitement aux opioïdes
Opioid treatment agreement between the prescriber and the worker.
Demande de traitement additionnel – Physiothérapeute
Physiotherapist's request for treatment beyond the authorized period.
Premier rapport du chiropraticien
Chiropractor's first report: injury, objective findings, treatment plan and work capacity.
Rapport du chiropraticien sur l’évolution du patient
Chiropractor's progress/discharge report.
Formulaire de rapport initial de gestion des opioïdes
Prescriber's initial opioid management report for a worker on a WCB claim.
Rapport sur l’évolution de la gestion des opioïdes
Prescriber's follow-up opioid management report.
Rapport sur l’évolution/la fin de la prise en charge du patient en physiothérapie
Physiotherapist's progress or discharge assessment report.
Rapport initial de physiothérapie
Physiotherapist's initial assessment report.
Formulaire Vérification de l'invalidité
Verifies a permanent or persistent/prolonged disability and its functional limitations for Canada student grants for students with disabilities (including Services and Equipment).
Request for medically essential equipment and devices for clients of Employment and Income Assistance, Children's disABILITY Services or Community Living disABILITY Services.
Request for medical supplies for EIA, Children's disABILITY Services or Community Living disABILITY Services clients.
Request for a therapeutic diet allowance or nutritional supplements (approval not to exceed 12 months) for EIA and disABILITY services clients.
Request for wheelchair seating components through the Materials Distribution Agency for DHSU program clients.
Physiotherapist or athletic therapist's initial report on a PIPP injury claimant (symptoms, signs, outcome measures, diagnosis, injury category, work status).
Physiotherapist or athletic therapist's follow-up report on treatment response and status for a PIPP claimant.
Physiotherapist or athletic therapist's discharge report at the end of PIPP-funded treatment.
18-019-416Chiropractor's health care report on a PIPP injury claimant, including work-capacity assessment and patient authorization.
MCA-Form-157-2021Mandatory report by a physician or optometrist (Drivers and Vehicles Act s.18.2(1)) of a disease or disability that may interfere with safe driving; starts a driver fitness review.
Vision report requested by MPI Driver Fitness for vision recall, second opinion, Medical Review Committee, class applicants, failed standards or medical/visual suspension.
Driver fitness medical requested by MPI Driver Fitness: class applicant, class recall, Registrar recall or requirement, suspension, or Medical Review Committee.
Manitoba Blue Cross copy of the industry initial medical statement for disability benefit claims.
Attending physician's statement for a critical condition benefit application.
Recommendation supporting a claim for assisted care or private nursing services.
Pre-authorization or claim for custom orthotics and orthopedic shoes or modifications.
Physician report supporting a Manitoba Blue Cross trip cancellation claim: diagnosis, first visit, hospital confinement, and whether the condition precluded travel.
General prescriber request for Exception Drug Status coverage of a Part 3 drug under Manitoba Pharmacare and other provincial drug programs.
Special authorization request for continuous or flash glucose monitoring coverage.
Family of drug-specific EDS request forms (e.g., CGRP agents, atopic dermatitis biologics, Entresto, Kerendia, Praluent/Repatha, Vascepa, asthma biologics, MS drugs, oral anti-diabetics).
Drug-specific Exception Drug Status request for oral anti-diabetic medications.
Accessible parking permit application (temporary 3-36 months or permanent; vehicle or motorcycle) that the healthcare provider starts for a 'physically disabled person'.
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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Yes. Section 18.2(1) of The Drivers and Vehicles Act requires physicians and optometrists to report a disease or disability that may interfere with safe driving. Use the Report to Registrar of Motor Vehicles (MCA-Form-157-2021) and send it to MPI Driver Fitness by fax, email or mail. The report starts a driver fitness review.
Physiotherapists and athletic therapists complete MPI's Initial Therapy Report, Subsequent Therapy Report and Therapy Discharge Report, and chiropractors use the Chiropractic Report (18-019-416). The initial report records symptoms, outcome measures, diagnosis, injury category and work status. The initial and subsequent reports have French versions as Word documents. Send reports to MPI by fax, email or mail.
Use a drug-specific EDS form if one fits; the Pharmacare health professionals page lists 33. Otherwise use the general Exception Drug Status (EDS) Request Form, which physicians and NPs complete with their licence number and fax to Manitoba Pharmacare. Coverage criteria are in the EDS notice, and some approvals are indefinite. A personal care home version of the form also exists.
The physician, after the first visit for a workplace injury. It covers the injury plus fitness for modified work and restrictions, and WCB Manitoba pays an initial report fee; optometrists bill the same report code. Use the Doctor Progress Report for progress and discharge. Chiropractors file their own Chiropractor First Report (4C) and Chiropractor Progress Report (7C).