MSQC Data and Report Request Form
To help MSQC participating hospitals fulfill their mission to improve the quality of surgical care, we aim to provide adhoc reports and data sets efficiently and accurately. This form helps us streamline your request(s) for data and/or reports by collecting the necessary information for each project.

The Data and Report Request Form will take approximately 5 - 10 minutes to complete. If applicable, you will want to have available your project description/project protocol, your IRB Approval letter, and have a clear idea of the variables you will need for your investigation.

Please allow 2 - 3 weeks to receive your request, as the time necessary to complete each request varies on complexity of request and number of requests in the queue at any given time.

If you have any problems or questions, please contact:
MSQCCustomerSupport@med.umich.edu

Please acknowledge/confirm the following:
1) I have read and understand the terms of the MSQC Data Request Policy (https://goo.gl/oSYHbs)

2) MSQC will be acknowledged as a source of information in materials presented and/or published.

3) I attest that any publication(s) resulting from this data will meet the Patient Safety Organization (PSO) standards of contextual non-identification of patients, hospitals, and/or medical professionals and remain in accordance with the Patient Safety Act (42 CFT Part 3)

I have read and understand all of the above. *
Required
MSQC Hospital Name/Institution Name *
Your answer
Full Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Please give a brief description of your project or research plan. *
Your answer
Start Date *
Please select the start date of the time period requested for this project.
MM
/
DD
/
YYYY
End Date *
Please select the end date of the time period requested for this project.
MM
/
DD
/
YYYY
Select the type of data being requested. *
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