1. FIRST NATIONS COMMUNITY ELECTRONIC medical RECORD
PARTNERSHIP BETWEEN MANITOBA & BRITISH COLUMBIA FIRST NATIONS

2. Health Information Management
Hello its great to be here to talk about Mustimuhw and the benefits that have been realized in First Nations communities from it use. My name is Steve Sagodi and I’m the Solution Architect for the product.
Mustimuhw pronounced Moose tee mook, is a Coast Salish word, meaning all of the people.
Mustimuhw was conceived by Cowichan Tribes to meet the information needs of the Tsewulhtun Health Centre and has since evolved to incorporate the requirements of many First Nation health centers in Canada. Mustimuhw provides a model for integrating health information technology into community health services delivery.
The paper-charting method of record keeping was requiring staff to spend a considerable amount of time at the Tsewulhtun Health Centre looking through charts for information. This resulted in less time spent by the health care staff interacting with the members, and ultimately less care.
Tsewulhtun wanted a system which would empower the frontline staff to be more effective in caring for their community members. This also meant a system that could be used at the various points of service delivery, which included the health centre, schools, homes, etc. These requirement drove the creation of a community EMR solution. The solution allows the health center to operate without maintaining a paper chart for all of the programs and services it delivers.
MUSTIMUHW
( pronounced Moose tee mook )

3. Product Profile Name Mustimuhw cEMR Vendor Cowichan Tribes Location
Duncan, British Columbia
Installations
BC, SK, MB
Platform
Runs on Windows
Architecture
Client Server or ASP model
Licensing
Annual/per user
Not for profit business model
Mustimuhw was developed by Cowichan Tribes and is now operated as a distinct business entity which has an eHealth team specifically responsible for:
overseeing the evolution of the product
supporting the installed base of customers, and
making Mustimuhw available to new First Nation health centers which wish to adopt the application
Cowichan Tribes is located in and around the Cowichan Valley and Duncan, British Columbia. Cowichan is one of the largest First Nations in British Columbia.
Mustimuhw is being widely used by nations in BC, with a growing presence in Saskatchewan and Manitoba. You’ll be hearing more today about the benefits realized by the Manitoba communities who have implemented the system.
Mustimuwh is a Windows based application which can either be installed in a client server model within a facility or as hosted model utilizing application virtualization technology called XenApp. First Nations information governance is rooted in a set of principles referred to as OCAP. First Nations desire is to have Ownership, Control, Access, and Possession of their community health information. These principles have led to the installation of the Mustimuhw server in the community.
Mustimuhw is operated on a non-profit business model. Licensing costs are set to cover the expenses of operating a team to provide eHealth services to communities and to be able to evolve the product to meet evolving information management requirements. The licensing model is based on a per user basis paid annually. A typical agreement is for a 3 year period.

4. WHAT IS A cEMR?
A computerized medical record created specifically for First Nation community based health organizations
Integrated use amongst multi-disciplinary & para-professional care teams
Community, family & cultural focus
Enabling client participation & empowerment
Supporting the specific range of programs, services & workflow in FNs community based organizations
Community based health care has greater emphasis on the interaction between the member and the health service provider. The system supports family-centered care, a central tenet of First Nations culture. Because MUSTIMUHW allows each Nation to incorporate their own pictures, cultural
symbols and teachings, it supports the integration of health care into the culture of the community.
Most physician based EMR’s are designed around encounters and are tailored to support the billing requirements of a private physicians office. First Nations health centers provide services free of charge to members so billing is not a requirement which has influenced the product design.
The services are delivered by a combination of nurses and allied professionals and para-professionals. Charting is not focused on diagnosis and prescriptions but instead on assessments, narratives, and ensuring that members are following and accessing the appropriate health care services.
The functions or modules in Mustimuhw have been created to support the programs typically offered at health centers. The Child Oral Health Initiative is a great example of this. COHI is a dental initiative designed to prevent and control tooth decay in young First Nations children and to set the stage for a lifetime of healthy teeth. The program which is funded by Health Canada and implemented in the health centres provides education, fluoride varnish, temporary fillings for baby teeth, sealants and chewing gum designed to reduce bacteria in the mouth. Mustimuwh has purpose built functions for supporting the information management needs of this program and the associated reporting requirements of Health Canada.
Each federally or provincially funded program comes with a set of reporting requirements that the health centre must provide to the government agency funding the program. Mustimuhw reduces the burden on health centre’s for collecting and aggregating the health care information required in the program reporting requirements.
It also provides the health director and community leaders with the necessary information to help guide the appropriate allocation of scarce resources.

5. UNDERSTANDING A cEMR
Mustimuhw meets the electronic charting needs of First Nation health centres and service providers
Designed by First Nations for First Nations
Charting designed for nurses
Modules for First Nation health specific programs
Reports designed to meet the funding requirements of Health Canada/INAC/P&T
Community based health care has greater emphasis on the interaction between the member and the health service provider. The system supports family-centered care, a central tenet of First Nations culture. Because MUSTIMUHW allows each Nation to incorporate their own pictures, cultural
symbols and teachings, it supports the integration of health care into the culture of the community.
Most physician based EMR’s are designed around encounters and are tailored to support the billing requirements of a private physicians office. First Nations health centers provide services free of charge to members so billing is not a requirement which has influenced the product design.
The services are delivered by a combination of nurses and allied professionals and para-professionals. Charting is not focused on diagnosis and prescriptions but instead on assessments, narratives, and ensuring that members are following and accessing the appropriate health care services.
The functions or modules in Mustimuhw have been created to support the programs typically offered at health centers. The Child Oral Health Initiative is a great example of this. COHI is a dental initiative designed to prevent and control tooth decay in young First Nations children and to set the stage for a lifetime of healthy teeth. The program which is funded by Health Canada and implemented in the health centres provides education, fluoride varnish, temporary fillings for baby teeth, sealants and chewing gum designed to reduce bacteria in the mouth. Mustimuwh has purpose built functions for supporting the information management needs of this program and the associated reporting requirements of Health Canada.
Each federally or provincially funded program comes with a set of reporting requirements that the health centre must provide to the government agency funding the program. Mustimuhw reduces the burden on health centre’s for collecting and aggregating the health care information required in the program reporting requirements.
It also provides the health director and community leaders with the necessary information to help guide the appropriate allocation of scarce resources.

6. ALIGNMENT WITH HEALTH CENTRE BUSINESS REQUIREMENTS
Community Health Nursing
Maternal Child Health
Immunizations
Chronic Disease Management
Child Oral Health Initiative
Mental Health Counseling
Home and Community Care
Patient Travel/Medical Transportation
The core programs supported by Mustimuhw and offered in thhe majority of First Nations health centers are listed.

7. PRODUCT ARCHITECTURE Desktop application that runs under Windows
Locally installed, or remote server version
Designed to support
multi-site practice groups
remote locations
mobile workers
With a Mustimhw client server installation, a desktop client is installed on each workstation within the health center. These desktops communicate with a SQLAnywhere database server over the local area network. The desktop application runs under multiple versions of windows and exports data to the Microsoft Office suite of programs.
Communities can choose to use application virtualization technology to access Mustimuhw where the application is not installed on the desktop but streamed over the network on demand. The XenApp server can be hosted wherever the nation wishes.
The software is designed to support a mobile workforce. SQL Anywhere’s data exchange and synchronization technologies extends information from the health center to encrypted databases on nurse’s laptops. It utilizes MobiLink which is a highly-scalable, session-based synchronization technology for exchanging data among relational databases. The application has been designed to support up to 99 remote computers. Computers can securely and efficiently bi-directionally exchange information over the internet.

8. PRODUCT ARCHITECTURE Customizable charting templates
Full disconnected use capability
Lab result interfaces in British Columbia
Home Care reporting interface for Health Canada
Future integrations planned with Panorama and VIHA Pathways
The application has an extensible charting framework which allows communities to design custom templates for recording data. Each charting format can have an associated custom form template. When the charting entry is completed the form is saved to the database. Mustimuhw incorporates an electonic signature for every charting entry which is made by a practitioner.
The MobiLink technology allows for full disconnected use of the application. When a nurse is in a remote community with no network access back to the health center they will still have full access to their patient charts and can record new charting entries as required. Once network access is available the application will seamlessly and securely synchronize with the server.
Mustimuhw is committed to incorporating standards and interoperating with provincial EHR systems. The system can currently receives electronic lab results from private labs in BC using HL7 2.x messages.
The application is also enabled for file based message exchange. The application is able to produce files which are accepted by Health Canada electronic Service Delivery Reporting system.
We are currently working on projects that will allow for interoperability with the Vancouver Island Health Authorities Pathways referral system and for the exchange of immunization data with Panorama, the public health information system which is being implemented by a number of provinces.

9. COMMUNITY-FAMILY-CULTURE
Culturally appropriate, and strength-based, programs that address social determinants of health, are more successful in a FN context
Mustimuhw cEMR provides a comprehensive record that members can relate to
includes community teachings & sayings
incorporates culturally appropriate language
Contextualizes member records within their family & extended-family context
Aboriginal – Status – On-Reserve/Off-Reserve classification
Cowichan Tribes has not always been a service provider to communities running the application. We previously sold the application to Nations on an as is basis and were not in the business of providing any associated services. Nor were we a service provider during the pilot project in Manitoba.
Cowichan recognized the need for a comprehensive health information solution for communities and we are now fulfilling that much needed role. Community can now rely on Mustimuhw and receive the needed training and support to be successful in their eHealth initiatives.
We will continue to improve the product to make it standards base, interoperable, and most importantly to ensure that it meets the needs of First Nation health information management

10. EMPOWERING MEMBERS
Service cultural of Members (clients) being part of health care team
Goal-setting & Success monitoring tools for Members
Member specific print-outs & summaries of various aspects of chart they can take away
Providers record charting notes in conjunction with members
Helps instill ownership over own health, & provide knowledge transfer & “words” to have in navigating broader health care system
Cowichan Tribes has not always been a service provider to communities running the application. We previously sold the application to Nations on an as is basis and were not in the business of providing any associated services. Nor were we a service provider during the pilot project in Manitoba.
Cowichan recognized the need for a comprehensive health information solution for communities and we are now fulfilling that much needed role. Community can now rely on Mustimuhw and receive the needed training and support to be successful in their eHealth initiatives.
We will continue to improve the product to make it standards base, interoperable, and most importantly to ensure that it meets the needs of First Nation health information management

11. Amc EHEALTH INITIATIVES
Telehealth, EHRs & EMRs, Panorama
Mustimuhw Pilot project
Interim eHealth Advisory Partnership
MFNs ICT Inventory
MFNs Technology Council
Building the MFNs Network Committee
Youth ICT Committee
Technology Development Committee
Manitoba First Nations ICT Training Initiatives Inc.
HISAP Readiness Assessments
AFN National eHealth Advisory Committee (NeHAC) & AFN ICT Working Group

12. MANITOBA FIRST NATIONS
63 First Nations in Manitoba
125,000 plus registered Manitoba First Nation members
62% live on reserve
60% are under 30 yrs
6 of the 20 largest First Nation communities in Canada are located in Manitoba

13. MANITOBA FIRST NATIONS
Dene
Cree
OjiCree
Ojibway
Dakota
50% (32) of Manitoba First Nations are northern and/or isolated communities
36% (23) are not accessible by all-weather roads

14. MUSTIMUHW use in mB
The goal of the MFNPWTG project was to reduce the significant impacts of foot ulcers & amputations through the development of a wait time guarantee for the prevention, care & treatment of diabetic foot ulcers in Manitoba First Nations (MFNs) communities.
The MFNPWTG project researched options & invested in hardware & software for 6 pilot sites. The initial goal was to implement in 8 sites, however jurisdictional issues led to 2 sites being eliminated.
Mabel to explain the MFNPWTG project & the jurisdictional issues
Go into how Mustimuhw was chosen as the cEMR

15. MUSTIMUHW logic model INPUTS Funding
Health Canada- wait times envelope national office
Separate envelope, not FN envelope
Sustainability funding from 2008 to current from FNIH MB
Stakeholder partnership
MFNs
AMC
Federal Government
Provincial Government
Clear Concepts
Saint Elizabeth Health Care
Cowichan Tribes
Mabel – explain these 2 pieces from the PWTG project

16. MUSTIMUHW logic model ACTIVITIES IT infrastructure Connectivity
Hardware
Software
Preplanning visit
Making Mustimuhw Your Own
Community level training
Technical and Mustimuhw support
Mabel – review the activities portion and how the training visits were done during the PWTG project
Darrick – speak a bit about the technical support that Clear Concepts provides; and your experience with the training of the communities
OUTPUTS
IT equipment purchased based on needs
Preplanning visit & Assessment
Customization, privacy policy & other information issues addressed
Capacity building carried out at the community level to build competency in software usage
On-going technical and Mustimuhw support made available to the communities

17. MUSTIMUHW logic model Health Canada reports at the touch of a button
SHORT-TERM OUTCOMES
Health Canada reports at the touch of a button
Compliance with reporting requirements
Easy scheduling & tracking
Can add current health forms directly into the cEMR
On-line charting and easy access to growth charts
Screening people with diabetes for risk of foot complications
Stores digital photographs of wounds
Right information at right time
LONG-TERM OUTCOMES
Integrated case mgmt & holistic care
Vaccine preventable communicable disease control
Community empowerment
Portability
Accountability & efficiency
Useful tool for health care providers to help improve health status of FNs
Increased job satisfaction among nurses & healthcare providers
Safe, reliable, quality care
Mabel – Do these 2 sets of outcomes

18. AMC acquired financial contributions from FNIH-MB for Fiscal Years to aid with project management, administration, communication & collaboration with MFNs, Cowichan Tribes, etc.
In March 2008 AMC took the Systems Champions to Cowichan to show their commitment to the partnership, as they continued to take Mustimuhw to its next level of functionality, security, implementation & support.
Mabel to explain the difficulties in obtaining funding for after PWTG; AMC tried to keep a linkage in place while the whole changeover to the new platform was occurring.

20. AMC continues to develop a business model & funding plan to allow for all interested MFNs to implement Mustimuhw.
A Mustimuhw Evaluation Plan was undertaken by AMC as part of Health Infostructure funding, to collaborate lessons learned & validate the upcoming business plan.
Mabel to explain business model & plan to fund the rest of the communities to include all 64 MFNs.
Darrick explain the Health Infostructure piece and how the projects funded are being included in a national eHealth plan for First Nations & Inuit Health Branch. Right now they are the only funders of the Manitoba piece of the partnership.
Mabel - review the Evaluation Plan’s validation of a FN cEMR that works would mean a lot to communities who need such documentation to pursue funding for its implementation.
Focus on the community piece – and how they are important to the project’s success; Community Champions are the ones that keep the systems going & are keen to building & sustaining community networks.

21. LESSONS LEARNED Pilot evaluation helped inform our future efforts
Evaluation input from 5 of the six FNs
Human resource limitations – 500 with diabetes, most multi.barriers.
Facilitates Storage and sharing of external information, but does not facilitate getting it there.

22. LESSONS LEARNED Difficulty / Complexity for end-user:
The majority (77%) of Health Centre end-users found it a friendly and easy to use application.

23. LESSONS LEARNED
Key positive outcomes identified by Health Centre respondents:
Access to Information
Time-saver
Easier reporting
Increased information security / confidentiality

24. MUSTIMUHW CURRENT SERVICE MODEL
All of the benefits to clients apply to diabetes care, module
Human resource limitations – 500 with diabetes, most multi.barriers.
Facilitates Storage and sharing of external information, but does not facilitate getting it there.

25. MUSTIMUHW cEMR II PROPOSAL
“Developing Interoperability for Manitoba First Nations”
Interoperability = ability of electronic medical systems to interface, or connect, to “talk to each other”
GOAL of project = develop & demonstrate interoperability between Mustimuhw (cEMR) & a primary care clinical information system (EMR), i.e. within same community or with primary care service providers outside the community, but who provide service to the on-reserve population.

26. CANADA HEALTH INFOWAY Expansion of Mustimuhw cEMR to 3 MFN communities
Mustimuhw cEMR Phase II Project
Expansion of Mustimuhw cEMR to 3 MFN communities
Community Selections & Readiness Assessments
Project Advisory Committee  CTFoH
Project management team
Project Liaison, ICT Network Liaison, Interoperability Team
housed at Manitoba eHealth & AMC eHealth report directly to AMC eHealth = Project Management Office

27. Application principles:
Improve patient wait times & healthcare through technology
Prevent disease & its complications, in particular Diabetes
Lisa to review the complications with obtaining funding to continue the Mustimuhw portion of the PWTG. The untrained communities were a great concern & the staff of the PWTG were leaving AMC. The PWTG Report & recommendations were still not finalized.
Explain how we used a Train the Trainer approach b/c of no actual training budget/funds. Trained Mandy & then she proceeded to train the other communities.
Waiting for Cowichan put AMC in a difficult position as there was no concrete date set for completion of the software upgrades. Some of the communities were being trained on old versions of software with the knowledge that a new version was to be rolled out. The MFNs made the request to get trained regardless of the issues.
Outcomes:
Contribute to meeting the objectives of the MFNTC Resolution & contribute to building the future Centre of Excellence
Increase ICT capacity in communities & community level decision-making, including business opportunities

28. Project Charter & Project Procurement Plan
Deliverables-based funding: receive $$ after completion & approval of documents, for example:
Project Charter & Project Procurement Plan
Project Sponsorship & Advisory Committees Formation
Master Project Plan & Change Management Plan
Community Site Selection & Engagement Reports
Service Delivery Model: Current & Future
Mabel to explain business model & plan to fund the rest of the communities to include all 64 MFNs.
Darrick explain the Health Infostructure piece and how the projects funded are being included in a national eHealth plan for First Nations & Inuit Health Branch. Right now they are the only funders of the Manitoba piece of the partnership.
Mabel - review the Evaluation Plan’s validation of a FN cEMR that works would mean a lot to communities who need such documentation to pursue funding for its implementation.
Focus on the community piece – and how they are important to the project’s success; Community Champions are the ones that keep the systems going & are keen to building & sustaining community networks.

29. PROJECT GOVERNANCE
Mabel to explain business model & plan to fund the rest of the communities to include all 64 MFNs.
Darrick explain the Health Infostructure piece and how the projects funded are being included in a national eHealth plan for First Nations & Inuit Health Branch. Right now they are the only funders of the Manitoba piece of the partnership.
Mabel - review the Evaluation Plan’s validation of a FN cEMR that works would mean a lot to communities who need such documentation to pursue funding for its implementation.
Focus on the community piece – and how they are important to the project’s success; Community Champions are the ones that keep the systems going & are keen to building & sustaining community networks.

30. The 1st FNs in Canada to receive funding from Infoway for community EMRs!
June 2011
Proposal Submitted
January 2012
Legal Agreement complete
Project Commencement
February 2012 Staff Procurement
Press conference announcing project
June 2013
Project end
Mabel to explain business model & plan to fund the rest of the communities to include all 64 MFNs.
Darrick explain the Health Infostructure piece and how the projects funded are being included in a national eHealth plan for First Nations & Inuit Health Branch. Right now they are the only funders of the Manitoba piece of the partnership.
Mabel - review the Evaluation Plan’s validation of a FN cEMR that works would mean a lot to communities who need such documentation to pursue funding for its implementation.
Focus on the community piece – and how they are important to the project’s success; Community Champions are the ones that keep the systems going & are keen to building & sustaining community networks.

31. PROJECT PRESS CONFERENCE DAY

32. PEGUIS FIRST NATION Community Info
Largest First Nation community in Manitoba, with a population of approximately 9042 people of Ojibway & Cree descent.
Located 190 km north of Winnipeg, MB, and has an area of 75,749.2 acres.
One of the first transferred communities in Manitoba Region
More concerns raised from staff than community – survey question –
My name is Terry Wilson, and I am one of three system champions for the Mustimuhw Program in Peguis. In 2001, I began my start at Peguis Health Services as a data entry clerk. In 2002 I moved to medical transportation. We have a staff count of 44. We have been using Mustimuhw now since 2009.

33. Benefits of Pwtg
With the support of MFN PWTG Pilot Project we were given tools to enhance our current diabetes program:
Mustimuhw install
Training, foot care instruments, dremels, doppler, printer and a digital camera to help enhance our community program
Wide range of abilities
Phased implementation by 1) capacity 2) benefit

34. COMMUNITY PROGRAMS Medical Transportation Program
Visiting Mental Health Therapists
General Dentist - Dental Therapist &COHI
Home and Community Care Program
Aboriginal Diabetes Initiative Program
Water Quality Program
Traditional Healing Program
NNADAP Program
Public Health – Baby Clinic - Immunizations
Footcare Program
Health & Wellness Program
Maternal Child Health
Vision Care Program
Canadian Prenatal Nutrition Program
DT and COHI – challenge
In-house training

35. Benefits of mustimuhw Benefits to Clients
Enhanced internal case-management & communication – continuity of care with follow ups
Standardized templates for service encounter charting
Benefits to Staff
Job satisfaction
Automatic data collection for reporting (efficiency)
Client wait times are decreased through faster charting
One-step charting and data collection

36. Outcomes Benefits to Management
Facilitates compliance with reporting requirements
Facilitates quality assurance
Facilitates employee activity monitoring
Increased capacity for change
Data collection
evidence-based programming
evaluation
advocacy
Capacity – to manage change, implement technology-based innovation to the community

37. COMMUNITY TESTIMONIALS
“The Mustimuhw program makes charting much more easy and efficient
to use. It decreases a lot of time charting in between clients, improving the
level of service.” Home and Community Care Program
“I find the use of the program extremely beneficial in that it cuts the time for
charting. The reports function make the month end reports a lot more easy
to compile. I like that the system gives reminders for certain activities,
Ie: foot screening, etc. The spell check function also makes for an easier
task, an I will continue to use the program.” Public Health Nurse
DT and COHI – challenge
In-house training
“the charting formats are easier than paper charts. It decreases a lot of time between clients, improving the level of service.” HCC

38. CANUPAWAKPA DAKOTA NATION
Community Info
Current Leadership – Chief Frank Brown, Councillor Mervin Demas, Councillor Gerald Sandy
Canupawakpa Dakota Nation, non-Treaty
Located in southwestern Manitoba
One of 5 Dakota Bands in Manitoba
Population of 600+, on reserve 300+
Language spoken – Dakota
One of the first transferred communities in Manitoba Region
More concerns raised from staff than community – survey question -

39. COMMUNiTY PROGRAMs
Community Health Promotion & Injury/Illness Prevention, Public Health Protection Communicable Disease Control & Management, Home & Community Care
CHNs, HCCNs, Health Care Aides, In Home Care Support, CHRs, Community Diabetes Worker, Visiting Dietician, Foot Care Nurse, Nurse Practitioner
Medical Transportation
Community Wellness
Addictions & Solvent Abuse, Mental Health, Crisis Intervention, Parenting Skills, Injury Prevention, Healthy Babies & Child Development,
Wide range of abilities
Phased implementation by 1) capacity 2) benefit

40. COMMUNITY TESTIMONIALS
“The Mustimuhw Program has been great for our Community. The nurses can provide better continuity of care. The Mustimuhw program is excellent for case management, you can easily see which programs have been involved with the client. I can’t imagine running my program without it.” Shelley Kirkup, HCCNM
“The Mustimuhw program is member focused, he/she can monitor their own strength of wellness.” Mental Health Coordinator
“We wish our health centre had the program, Sioux Valley considers CDN to be very fortunate to have the program.” Neighboring community, Sioux Valley Nurses
DT and COHI – challenge
In-house training

41. future
Continue the partnership & collaboration with all project partners
Establish a linkage to the Manitoba Regional Health Authorities electronic health systems.
Establish linkage to FNIH’s other electronic programs, e.g. CRW’s program – Medical Transportation Program
Sustainability & capacity building for IT support & costs associated with Mustimuhw program.
Capacity – to manage change, implement technology-based innovation to the community

42. PARTNERSHIP BENEFITS Sustainability costs IT Capacity
AMC – continued advocacy
IT Capacity
Clear Concepts – support & capacity building
eHealth development
Cowichan Tribes – product enhancements
Maintenance & Maximization
Community champions network
Cowichan Tribes - Software support
Partnerships developed

43. Wopida – Ekosani – Miigwech – Mahsi – Huy ch q’u – Thank You
Lisa Clarke– eHealth-Technology Coordinator
Assembly of Manitoba Chiefs
2nd Floor Portage Avenue
Winnipeg, MB R3B 2B3
Phone:
Fax:
Steve Sagodi – Mustimuhw Solutions Architect
Ts’ewulhtun Health, Cowichan Tribes
5760 Allenby Rd.
Duncan, BC V9L 5J1
Phone:
Fax:
Wanda Sandy – Health Director
Canupawakpa Dakota Nation
PO Box 11 Pipestone, MB R0M 1T0 Tel: (204) Fax: (204)
Terry Wilson – Medical Transportation Coordinator
Peguis First Nation
Box 88
Peguis, MB R0C 3J0
Phone:
Fax: