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Get AZ ADHS Trauma Data Quarterly Submission Form 2019-2024

Uma Data Administrator 150 N. 18th Avenue, Suite 540 Phoenix, AZ 85007-3248 Phone: (602) 542-1245 Fax: (602) 364-3568 REPORTING FACILITY INFORMATION Facility Name: Facility Address: DATA SUBMISSION INFORMATION Date data entry completed in the web registry for the quarter: 1 ASTR Quarter Reporting Quarter 2 3 4 Year Number of Records Case Date Range Applied to this Data Submission ED/Hospital Arrival Dates through REPORTING FACILITY TRAUMA REGISTRY STAFF INFORMATION Contact Name: Pho.

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