Overdose Fatality Review TA Request Form

Thank you for your interest in Overdose Fatality Review-Public Health and Safety Teams!

The Drug Overdose Prevention Unit is available to support the implementation of Overdose Fatality Review (OFR) under the Public Health and Safety Team (PHAST) Framework amongst organizations in Minnesota.

Please complete the form below to submit your request for technical assistance, training, or other support. Someone will follow up with you within 10 business days.

Date:

M-D-Y

First and Last Name:

* must provide value

What county is your organization located in?

* must provide value

Organization Affiliation, if applicable:

If you are from a government agency, please include the division, program and/or Tribe you represent:

Role, Title or Position:

Email:

Phone number:

Which of the following best describes your request?

General Questions about OFR-PHAST

REDCap Training and Support

Data Request (SUDORS or case lists)

Other

Has your team received training and access to the MDH OFR REDCap Database?

Yes

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Please describe your request:

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What particular communities is this request associated with? (Please include region, county, city (if applicable), audience, or other considerations for accessibility. This helps us connect you with someone best suited to respond to your request.)

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How did you learn about OFR-PHAST teams?

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