FINGER LAKES DATA USE AGREEMENT

[Regional Data Sharing]

 

To receive Finger Lakes Regional Perinatal Data System data you must:

Review the following conditions for data release, sign this form and fax it to the Finger Lakes Regional Perinatal Data System (585.276.2333) prior to receiving the requested database.

 

  1. You have requested data from the Finger Lakes Regional Perinatal Data System.  This data is collected from all birthing hospitals in the Finger Lakes New York Region.  It is critical that this information be released carefully and with all assurances of complete confidentiality.

 

  1. The data you have requested may not be re-released by you under any circumstances without the prior approval of the Finger Lakes Regional Perinatal Data System.  This includes distribution of the data file or a subset of the data file, publication or public presentation that includes this data by any person other than the person signing this agreement.

 

  1. This information has been released for the purposes of:

o       providing supportive information for grant applications

o       comparative analyses

o       inclusion in the Western New York Region PDS

 

You are not authorized to use the information requested beyond the above stated purposes.

This Authorization Form DOES NOT permit the data requester to use the data

for research purposes.

 


  1. Please include, when faxing this signed form, a statement specifying the data elements and years of data requested and any other specific criteria important to your study.

 

  1. This data is for your exclusive use only. You must maintain these files in a password protected file, accessible only to you. Failure to comply with this agreement will limit your access to additional PDS data and will be reported to your institution.

 

If you have any questions about any of the above, or have any questions about the data provided, please don’t hesitate to contact Joseph Duckett (Joseph_Duckett@urmc.rochester.edu)

 

 

 

___________________ __________          ____________________  __________

Ann Dozier, Ph.D.             Date                             Data Requester             Date

 

University of Rochester

Division of Public Health Practice · Department of Community and Preventive Medicine

601 Elmwood Avenue, Box 278969 · Rochester, New York 14642 · 585-758-7840 (voice) · 585-424-4485 (FAX)