2021 Optional Case and
QI Project Declaration

Please complete the form below to let the MSQC Coordinating Center know your optional case selection and QI project declaration for 2021. This is due by December 18, 2020.

Note: for large volume or bed-size hospitals, we will reach out to you individually to verify your additional volume selection for 2021

2021 Optional Case and QI Project Declaration
Your Role *

2021 Optional Case Selection Declaration

Please select one option below *

2021 QI Project Declaration

Please select one option below *

For Option A: You must select Hysterectomy as a Case Selection
For Option C: You must have received prior notification from MSQC indicating that your site is eligible to participate
Please enter the Name of the OB/GYN who will be the Project Champion
Please enter the Title of the OB/GYN who will be the Project Champion
Please enter the Email of the OB/GYN who will be the Project Champion

Declaration

Please check the box below *