Submit a Case to WebM&M

Health care professionals may anonymously submit cases that highlight medical errors or other patient safety/quality issues. Submitters of selected cases will receive $300, paid anonymously through PayPal. Please click here for more information on selection criteria and honorarium. When a case is selected, the editors invite an expert author to write a commentary based on the case.

This form should only be used to submit factual cases of medical errors or patient safety issues. Do not use this form to submit an article. If you would like to contact the editors; send a question, comment, or suggestion; or provide feedback on this Web site, please use the Contact Us form.

Case submissions are anonymous. Do not provide any personally identifiable (patient or provider) information, and do not use institution names or locations.

HIPAA Warning: Do NOT include any information in your submission that could identify the individuals involved or reveal Personal Health Information (PHI), which is a violation of HIPAA privacy rules. Any submission with such information relating to PHI is not the responsibility of AHRQ WebM&M nor any of its affiliates.

Submit a Case to WebM&M

Please recommend an appropriate title for the case.

Briefly describe the patient (much as you would in a case summary) at the time of the event of interest. (250 words maximum)

Describe the nature of the error and any relevant events or contributing factors. (250 words maximum)

Briefly describe the impact of the error on the patient and state whether or not the patient was harmed at all or required increased level of care, even if only temporary. (250 words maximum)

If not noted above, briefly describe how the error was recognized. (250 words maximum)

Briefly, describe your suggestions for how providers or systems might prevent similar errors from happening in the future. (250 words maximum)

AHRQ WebM&M is an educational journal. Please note that cases submitted to our site are not forwarded to any other reporting systems. If you believe it would be desirable (or, in the case of mandatory reporting systems, required) to report your case to another site, please do so independent of your submission to AHRQ WebM&M.

Follow Up Email

Enter your email so that we can contact you in the event that your submitted case is selected

The email address you provide to us is used only for contacting you in the event your case is selected, and no other use is permitted.

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