Get Project Requests Form - Uw Departments Web Server - University Of ...

The Project Requests Form is essential for individuals seeking customized data retrieval from the ASA Closed Claims Project. This guide provides clear, step-by-step instructions on how to complete the form effectively and efficiently, ensuring users can submit their requests with ease.

Follow the steps to fill out the Project Requests Form online

1. Press the ‘Get Form’ button to access the Project Requests Form and load it in your preferred editor.
2. In the first section, provide your ASA Member Information, including your name, ASA member number (required), postal address, email address, and telephone number. Specify your membership status as either an active or retired anesthesiologist or a resident/other member requiring a mentor.
3. If applicable, include the mentor's information, confirming they are an ASA member. Ensure you list their member number, postal address, telephone number, and email address.
4. Indicate the shipping information by selecting the delivery method for the data. Complete the date needed for receiving the information, and remember that 'ASAP' is not a valid option.
5. Describe your research question, hypothesis, or topic of interest in detail. Specify any restrictions related to patient population, time period, or case characteristics.
6. Fill in information regarding the surgical procedures and anesthetic techniques relevant to your request, as well as chronic pain management specifics, if any.
7. State how the retrieved data will be used by checking all applicable boxes related to personal use, education, research, or presentations. Be sure to note if you intend to include the information in any written materials.
8. Carefully read and acknowledge the statement of the Data Use Agreement and the Conflict of Interest Statement. Make sure to sign and date the document.
9. Once all sections are thoroughly completed, save your changes, and you may decide to download, print, or share the form as needed.

Complete your Project Requests Form online today to ensure timely processing of your data request.