Editing a Locked Completed Case Form

Please use this form if you need to edit a locked completed case. Once your request is received by the Data Management Team, your request will be reviewed within two business days. If you have multiple cases with the same variable changes needed, you can submit one form and list out all of the case numbers. In general, cases will not be unlocked to complete abstraction of cases but only for edits of previously completed cases. If you require special accommodations to allow for more than 120 days to complete case abstraction, please contact OBI-CDA-Support@med.umich.edu. **PLEASE DO NOT SUBMIT HIPAA SENSITIVE INFORMATION IN THIS FORM**

Hospital

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Case Number(s)

{name}

Infant Date of Birth

Reason for Edit Request?

If changing data, what variable(s) need to be edited?

{name}

If changing data, what is the current abstracted data for the variable(s)?

{name}

What is the edit being made for the variable(s)?

{name}

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