ERROR CORRECTION FORM FOR ANNUAL POPULATION MORTALITY REPORTING FORM (ICD-8)
Form: D Version: 2 7.9.87
Seq.no:
Received:
MONICA Manual, Part II, Section 1
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Annual Demographic and Mortality data ERROR CORRECTION FORM FOR ANNUAL POPULATION MORTALITY REPORTING FORM (ICD-8) Form: D Version: 2 7.9.87 |
FOR MDC USE ONLY Seq.no: Received: |
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| A. Annual mortality data was reported on the attached form, with MDC Sequence Number: | |___|___|___|___|___|___| | |
| B. MONICA Collaborating Centre: | |___|___| | C. MONICA Reporting Unit:|___|___| |
| D. Calendar year: | |___|___|___|___| | E. Sex: 1. Males, 2. Females |___| |
| F. This error correction form was generated on (day, month, year) | |___|___|___|___|___|___| | |
| G. The MONICA Data Centre has reviewed the information provided on the form identified above and noted the possible inconsistencies as indicated on the attached Population Mortality Reporting Form. Please review these carefully and record the appropriate changes below in accordance with the instructions for this Error Correction Form. In particular, please write numbers only in the cells where a correction is required. | ||
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| H. | Person completing this error correction form: | ___________________ (Please type or print) |
___________________ Signature |
Date: _____/_____/_____ day month year |
| I. | Comments or reservations about data provided: | |||
This form was designed to facilitate communication between the MONICA Data Centre (MDC) and the MONICA Collaborating Centre (MCC) about possible errors or uncertainties for data previously reported by the MCC to the MDC on an Annual Population Mortality Reporting Form. Its use is to be initiated by the MDC, which should complete parts A, B, C, D, E and F, and attach the otherwise blank form to a copy of the Annual Population Mortality Reporting Form in question and then send both to the MCC. The MCC should then complete the Error Correction Form and return it to the MDC. The MCC should keep a copy of the completed Error Correction Form.
This form should be sent to the MCC, with items A, B, C, D, E and F completed, soon after the MDC receives the Annual Population Mortality Reporting Form from the MCC. It should be used only if there are questions about the information provided to the Reporting Form.
This form can be completed either by typewriter or by hand. In either case the recorded information should be examined carefully for both correctness and legibility. Further, since it may be necessary to photocopy the form, perhaps several times, as a routine part of processing and providing reserve copies, it is essential that the recorded information be clear and dark. Hence, please use a dark ribbon if a typewriter is used, or a dark ball-point pen if the form is completed by hand.
This form includes blank spaces where you are to record the requested information. None of these spaces should be left blank. If you have no information to provide for a specific item, then so indicate according to the instructions for that item.
These instructions should be followed carefully when completing the indicated version of the Error Correction Form for the Annual Population Mortality Reporting Form. Please ensure that the instructions are for the version of the form being completed. Specific instructions are listed by item below:
| A. Annual mortality data was reported on the attached form, with MDC Sequence Number: | |___|___|___|___|___|___| | |
| B. MONICA Collaborating Centre: | |___|___| | C. MONICA Reporting Unit:|___|___| |
| D. Calendar year: | |___|___|___|___| | E. Sex: 1. Males, 2. Females |___| |
| F. This error correction form was generated on (day, month, year) | |___|___|___|___|___|___| | |
These six items are to be completed by the MONICA Data Centre. The information should be clearly written or typed and should agree with the official MONICA Collaborating Centre and Reporting Unit names and code numbers (see Part I, Appendix 2). (The MDC Sequence Number is assigned and used by the MDC only.)
The MDC should ensure that a clear copy of the appropriate Annual Population Mortality Reporting Form is securely attached and that the questions about the information recorded on the Reporting Form are clearly and unambiguously identified and described.
| G. The MONICA Data Centre has reviewed the information provided on the form identified above and noted the possible inconsistencies as indicated on the attached Population Mortality Reporting Form. Please review these carefully and record the appropriate changes below in accordance with the instructions for this Error Correction Form. In particular, please write numbers only in the cells where a correction is required. |
| ICD-8 category | Number of deaths for the selected ICD categories in these age groups | Total of the row | |||||||||
| 25-29 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65-69 | 70-74 | ||
| Total deaths | |||||||||||
| 000-136, 320, 470-486 | |||||||||||
| ..... | .... | .... | .... | .... | .... | .... | .... | .... | .... | .... | ...... |
| E950-E959 | |||||||||||
| Total of the column | |||||||||||
| Source of information: | |___| |
The section of the form represented above is to be used by the MCC to indicate changes that should be made to the information as originally provided on the Reporting Form. No item should be left blank.
The MDC has circled the questionable items and commented as to why the items were thought to be incorrect on the Population Mortality Reporting Form attached to the Error Correction Form.
In each cell of the table of the Error Correction Form, for which the information provided to the MDC on the Population Mortality Reporting Form was incorrect, print or type in the revised information.
If the value questioned by the MDC is correct as originally reported, that is, if the value questioned by the MDC is correct and should not be changed, so indicate by writing "OK" in space provided.
For those items not questioned or for which no new information is available, place an "\" in the appropriate space.
An example of an Error Correction Form and the questioned Population Mortality Reporting Form as they might be received in the MCC, and a completed Error Correction Form are provided at the end of these instructions.
| H. | Person completing this error correction form: | ___________________ (Please type or print) |
___________________ Signature |
Date: _____/_____/_____ day month year |
Type or print the name of the person completing this form and the date completed in the spaces provided. Note that this form is to be completed by the MONICA Collaborating Centre Principal Investigator, or his or her designate.
I. Comments or reservations about data provided:
Type or print any reservations or comments about the data that may be helpful to the MDC in understanding the changes provided. If necessary, attach additional sheets.
An example of the error correction form and the marked population mortality reporting form as the MCC receives them:
An example of the completed form, as the MCC returns it to the MDC:
