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Submit a Case

Note that your name will not be publicly associated with the case
  • The content of case submissions is anonymous. Do not provide any personally identifiable (patient or provider) information, and do not use institution names or locations.
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  • 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 this nor should be or any of its affiliates.
  • AHRQ’s PSNet is not a confidential patient safety reporting system or a patient safety organization. Information that is privileged and confidential under the Patient Safety and Quality Improvement Act of 2005 (information that is “patient safety work product”) should NOT be submitted to AHRQ PSNet WebM&M.
  • The information submitted to WebM&M is subject to the Freedom of Information Act, 5 U.S.C. § 552. AHRQ may decline to review or accept a submission for any reason in its sole discretion. PSNet does not provide expert witness services or adjudicate claims of medical error.
Please recommend an appropriate title for the case. (20 words maximum)
Briefly describe the patient (much as you would in a case summary) at the time of the event of interest. (500 words maximum)
Describe the nature of the error and any relevant events or contributing factors. (500 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. (500 words maximum)
If not noted above, briefly describe how the error was recognized. (500 words maximum)
Briefly, describe your suggestions for how providers or systems might prevent similar errors from happening in the future. (500 words maximum)

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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.

Once the case has been submitted, you will not be able to further edit the case.

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.

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