FINGER LAKES DATA USE AGREEMENT

[Request for Summary or Aggregate Data**]

 

To receive Finger Lakes Regional 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 report.

 

  1. You have requested aggregate or summary 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. This information has been released for the purposes of:

o  providing supportive information for grant applications

o  comparative analyses

 

  1. When faxing this signed data release form, please include a statement describing the data elements and years of data to be included in the final report.

 

  1. If you are not familiar with the Perinatal Data System (PDS), it is strongly recommended that you involve a PDS expert to assist you with the interpretation of the report data.

 

  1. Data from small areas or with small sample sizes will not be released to protect patient confidentiality.

 

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

 

** This form cannot be used to request individual/raw data.

 

 

 

 

 

 

 

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)