Get Pharmacare Application Form

Filling out the Pharmacare Application Form online can seem daunting, but with the right guidance, you can complete the process smoothly and efficiently. This guide will provide you with clear, step-by-step instructions on how to fill out the form to ensure you can access the benefits you deserve.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin filling in the applicant's surname and given name in the respective fields. Ensure that the names are spelled correctly as they appear on official documents.
3. Indicate the current marital status by selecting the appropriate checkbox. Options include married/common law, separated, single, or widowed.
4. Input the Manitoba Health Registration Number and Personal Health Identification Number (PHIN) for the applicant in the corresponding sections.
5. Fill in the Social Insurance Number (SIN) and the current address, including city/town and postal code.
6. If applicable, provide the spouse's surname, given name, Manitoba Health Registration Number, PHIN, and SIN in the specified fields.
7. Answer the questions about whether a Power of Attorney is signing on behalf of the applicant and/or spouse. If yes, be sure to attach copies of the Power of Attorney documents.
8. Indicate if the applicant or spouse resides in a Personal Care Home by checking the appropriate box for yes or no.
9. Review the section regarding the one-time program enrollment. Confirm understanding of the automatic process and the annual deductible.
10. Read the consent section carefully and sign the form where indicated, along with the spouse’s signature.
11. Fill out the declaration section, ensuring all information is complete. Sign and date this section as well.
12. Once all sections are completed, save your changes. You can then download, print, or share the completed form as needed.

Start your online application process now to secure your Pharmacare benefits!