Replacement Card Optional

Manitoba Health, Seniors and Long-Term Care

Plastic replacement card - optional PHIN

This replacement card request will result in a new individual plastic Manitoba health card being issued to you.

Family health cards are no longer printed, but existing cards remain valid.

⛔Please confirm your health card information is up to date

Have you ensured that information on your current health card is up to date? This includes any change in status such as:

Marriage, Legal separation, Divorce
Birth, Adoption
Name Change

YesNo

Cardholder's information

Registration number (six-digit alphanumeric)

Personal Health Identification Number (PHIN - nine digits)

Primary phone number

Email address

Can we contact you at this email address?

Legal first name

Legal middle name

Legal last name

Date of birth

Select either English or French as your official language

Current address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Is your mailing address the same as your current address?

Mailing address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Reason for request

Specify your reason for request

Will you require a change of address?

New residential address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Is the new mailing address the same as the new residential address?

New mailing address

Apartment/unit number

Street address (or PO box number)

City

Province

Postal code

Form completed by

Legal first name

Legal last name

Relationship to applicant

Branch name

Specify your relationship to the applicant

I certify that the information contained herein is true. Section 42 of The Health Services Insurance Act provides for a fine of up to $5,000 for a person convicted of making false and misleading statements.

Generate a new image Play the audio code

Enter the code from the image