UEMF

Data Request

Request for Information

If there is any information about hospitals staffed by UEMF employees that you would like, please fill out the following request form. Once you submit your request, a member of UEMF's Business Intelligence team will process the request and send you the information. Please note that some of the requests may take up to 2-4 weeks, depending on complexity and other business-related events.

HIPAA Notice

In the event that you need to input a specific set of private information, Do not post any ePHI such as Medical Record Numbers(MRNs) or any other demographic or patient identification information here. The information you submit via this form will not be publicly displayed. If you need to make a request which includes private information, please email the request instead of filling out the form.

Report Information

Please explain who you are and when you need this report. Specify if the report needs to be run more than once, and if so, how often the report needs to be submitted.

Name is required and must be a valid name. (i.e. Jérémie O'Co-nor)
Email Address is Required and must be a Lifespan.org email address
Title is required
Date must be in M/D/YY format
Date must be in M/D/YY format


Fields to Display

What type of information are you looking for in your report?

Delete
No Fields

Filters

Narrow down your information results.
ex: Patient Birth Date > Jan 1, 2000

Field Name
Comparison
Filter Value

Filter #index#

Is
To/Than
Delete
No Filters

Summary

Are there any calculations you would like on your data?
ex: Count of Patients Seen per Month

Summary Type
Field to Summarize
Grouped By

Summary #index#

Delete
No Summaries

User Account Creation

Would you like us to create an account for you in our Ticketing System? Through this system you will be able to monitor the status and comment on your data requests.

Comments

Do you have any comments/concerns or other specifications for your request?