2022 Optional Case and
QI Project Declaration

Please complete the form below to let the MSQC Coordinating Center know your hospital’s optional case selection and QI project declaration for 2022.

This is due on December 17, 2021.

Note: for large volume or bed-size hospitals, we will reach out to you individually to verify your additional volume selection for 2022

2022 Optional Case and QI Project Declaration
Your Role *

2022 Optional Case Selection Declaration

Please select one option below *

2022 QI Project Declaration

Please select one option below *

For Option A: You must select Hysterectomy as a Case Selection
For Option C: If you did not select this option in 2021, please contact MSQC before selecting this option
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 *