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MIMS REPORTS
MIMS PHYSICIAN LISTING REQUEST
MANITOBA HEALTH
MIMS: PHYSICIAN LISTING REQUEST
To:
Supervisor/Data Control
Computer Services
3047-300 Carlton St.
Winnipeg, Manitoba R3B 3M9
Fax: 943-0972
Date:
JOB: A4MIPHYA
ALPHABETIC LIST OF PHYSICIANS
PROGRAM:
A4MI046 (EASYTRIEVE PLUS)
REQUIRED BY:
Y
Y
Y
Y
REQUESTING ORGANIZATION
M
M
D
D
RHA / HEALTH UNIT OFFICE
MAILING ADDRESS:
(FOR REPORT)
EMAIL ADDRESS:
SIGNATURE
NUMBER OF COPIES
NAME (PLEASE PRINT)
PHONE NUMBER
MI046.doc
(PLEASE COMPLETE ALL APPLICABLE FIELDS BOLDLY AND CLEARLY)
MIMS – Manitoba Immuniza on Monitoring System
164
VERSION: 1.0