Get Pharmacare Application Form

The Pharmacare Application Form is essential for individuals seeking eligibility for prescription drug assistance in Manitoba. This guide provides a clear, step-by-step approach to completing the form online, ensuring that you can navigate the process easily and efficiently.

Follow the steps to complete your Pharmacare Application Form online:

1. Press the 'Get Form' button to access the Pharmacare Application Form and open it in your preferred document editor.
2. Begin by entering the applicant's surname and given name in the appropriate fields.
3. Provide the Manitoba Health Registration Number, Personal Health Identification Number (PHIN), and Social Insurance Number (SIN) as requested.
4. Indicate the current marital status by selecting one of the provided options, such as married, common law, widowed, divorced, separated, or single.
5. Fill in the current address, city or town, telephone number, and postal code.
6. If applicable, indicate whether the Power of Attorney is signing on behalf of the applicant or spouse, and attach copies of the relevant documents if the answer is 'Yes'.
7. Indicate if the applicant or spouse resides in a Personal Care Home by selecting 'Yes' or 'No'.
8. Choose between Enrolment Option A or Option B based on your preference for application processing.
9. Sign the consent section, authorizing the release of pertinent information to the Manitoba Department of Health.
10. Complete the declaration section, confirming the accuracy of the information provided and ensuring no other coverage applies.
11. Both the applicant and spouse should sign and date the appropriate sections of the form.
12. Once all sections are filled, review the form for completeness and accuracy. Save your changes and download, print, or share as needed.

Start completing your Pharmacare Application Form online today!