Get Az Adhs Trauma Data Quarterly Submission Form 2019-2025

This guide provides you with comprehensive and user-friendly instructions on completing the AZ ADHS Trauma Data Quarterly Submission Form online. By following these steps, you will ensure your submission is accurate and meets all necessary requirements.

Follow the steps to fill out the form online effectively.

1. Press the ‘Get Form’ button to access the Trauma Data Quarterly Submission Form and open it for editing.
2. Begin by filling out the reporting facility information. Enter the facility name and address in the designated fields provided.
3. Proceed to the data submission information section. Record the date when data entry was completed in the web registry for the relevant quarter, and identify the ASTR quarter by selecting the appropriate option.
4. Indicate the year for the submission and provide the number of records included in this data submission. Make sure to specify the case date range applicable to the submission by entering the start and end dates.
5. In the reporting facility trauma registry staff information section, fill out the contact name, phone number, title, fax number, and email for the individual responsible for the data submission.
6. Note that the Trauma Registry Manager will send a signed form back to the facility contact as confirmation of receipt. For verification purposes, ensure the record numbers match the ASTR Trauma One Web record count, selecting 'YES' or 'NO' accordingly.
7. Finally, if there are any special instructions or comments, use the provided space to note them. After reviewing all the entered information for accuracy, you can save your changes, download, print, or share the form as needed.

Complete your AZ ADHS Trauma Data Quarterly Submission Form online today to ensure compliance and accurate reporting.