IMMUNIZATION RECORD UPDATE REQUEST
PRIVACY NOTICE AND CONSENT FOR DISCLOSURE OF
PERSONAL INFORMATION AND PERSONAL HEALTH INFORMATION
In order for the Government of Manitoba's Department of Health and Seniors
Care
("MHSC") to
process your update request and to make any updates to your immunization
record
(including
updating that you received a vaccination from outside of the jurisdiction),
personal information
and personal health information about you will be collected and must be
disclosed to third parties.
Please see below for more details.
COLLECTION OF YOUR PERSONAL INFORMATION AND PERSONAL HEALTH
INFORMATION
MHSC is collecting the following personal information and personal health
information for the
purposes of making updates to your immunization record (including verifying
your
identity and
conducting any investigations required to process your update request) and
for
contacting you
to provide the status of your update request:
- your full name;
- your date of birth;
- your personal health identification number (PHIN);
-
when and where you received your COVID-19 vaccine immunization, if
applicable;
-
record of immunization from the jurisdiction you received your vaccine
(if
received outside Manitoba), if applicable;
- your phone number; and
- your home address.
MHSC is authorized to collect your personal information under:
-
subsection 36(1)(b) of
The Freedom of Information and Protection of
Privacy Act
, C.C.S.M. c. F175 ("FIPPA"); and
-
subsection 13(1) of The Personal Health Information Act,
C.C.S.M.
c. P33.5 ("PHIA");
because collecting the information relates directly to and is necessary for
MHSC
to verify your
identity, conduct any investigations required to process your update
request,
update your information
on your immunization record, and contact you with the status of your update
request. MHSC will
only collect as much personal information and personal health information as
is
necessary.
Your phone number and/or home address will be used to contact you in order
to
provide you with
the status of your update request.
DISCLOSURE OF YOUR PERSONAL INFORMATION AND PERSONAL HEALTH
INFORMATION
MHSC will need to disclose your personal information and personal health
information to one or
more of the following entities:
- Shared Health Inc.;
-
Applicable Regional Health Authority:
- Winnipeg Regional Health Authority;
- Interlake-Eastern Regional Health Authority;
- Southern Health-Santé Sud Regional Health Authority;
- Prairie Mountain Regional Health Authority;
- Northern Regional Health Authority.
For members of the Canadian Armed Forces
- Canadian Forces 23 Health Services Centre Winnipeg;
- Canadian Forces 11 Health Services Centre Shilo.
for the purposes of conducting any investigations required to process your
update request and to
update your information on your immunization record.
In order for MHSC to process your update request, you will be required to
consent to MHSC disclosing
your personal information and personal health information to the entities as
described above.
MHSC will have the authority to disclose your personal information and
personal
health information
for the purposes indicated above under:
- section 44(1)(b) of FIPPA; and
- section 22(1)(b) of PHIA.
WITHDRAWAL OF YOUR CONSENT
You may withdraw your consent to the further disclosure of the personal
information and personal
health information provided on this form by contacting:
Your consent continues until you notify MHSC that you withdraw your consent.
Your consent cannot
be withdrawn retroactively.
If you do not provide consent or withdraw your consent prior to completion
of
your update request,
MHSC will not be able to process your update request.
QUESTIONS
Your personal information is protected under FIPPA and your personal health
information is protected
under PHIA. MHSC, Shared Health and the Regional Health Authorities will
only
collect, use and
disclose as much personal information and personal health information as is
necessary and cannot
disclose your personal information and personal health information for other
purposes, unless it is
authorized to do so under FIPPA or PHIA.
For any questions regarding the collection, use or disclosure of your
personal
information and personal
health information, please contact: