Analytic Interventions Unit Intake Form

Please complete the Intake Form below to begin a conversation with the AIU about your model. Whether you have an existing model or just an idea for one, this form is the first step for the AIU to evaluate its safety and feasibility. We look forward to working with you to improve patient care here at UChicago Medicine. If you have any questions, please email Kimisha.Cassidy@uchicagomedicine.org Thank you!

Stakeholder*

Email*

Model or Project Title*

Who built the model? (Please list external vendor or internal department)*

Is this an update to an existing model that is already in production at UChicago Medicine?

Has this project gone through IRB or QI Determination?

Click here for IRB
Click here for QI Determination

Explain the medical context, rationale, and objectives for using this model to improve patient care or clinical operations*

Please do not include PHI or any other sensitive information.

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Analytic Interventions Unit Intake Form

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