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add template for responses
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tompollard committed Dec 14, 2016
1 parent d0d8433 commit ad89160
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54 changes: 27 additions & 27 deletions DataUseAgreement.md
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Expand Up @@ -15,31 +15,31 @@ If I am granted access to the MIMIC Clinical Databases, I agree to the terms and
5. If I find information within restricted data from PhysioNet that I believe might permit identification of any individual, I will report the location of this information promptly by email to mimic-support@physionet.org, citing the location of the specific information in question so that it can be investigated and removed if necessary.
6. I have requested access to restricted data from PhysioNet for the sole purpose of lawful use in scientific research, and I will use my privilege of access, if it is granted, for this purpose and no other.
7. I have completed a training program in human research subject protections and HIPAA regulations, and I am submitting proof of having done so.
8. This agreement may be terminated by either party at any time, but my obligations with respect to restricted data from PhysioNet shall continue after termination.

My name:
My PhysioNetWorks username:
Telephone number, including country/area code (required):
Institution:
Title or position:
Street address:
City:
State/Province:
ZIP/postal code:
Country:

Name of human studies training course completed:
Date completed:

* Supervisor's name:
* Supervisor's telephone number:
* Supervisor's email address:
* Supervisor's title:
(* information required for students and postdocs)

General research area for which the data will be used:

Date of this agreement:

8. This agreement may be terminated by either party at any time, but my obligations with respect to restricted data from PhysioNet shall continue after termination.
My name:
My PhysioNetWorks username:
Telephone number, including country/area code (required):
Institution:
Title or position:
Street address:
City:
State/Province:
ZIP/postal code:
Country:
Name of human studies training course completed:
Date completed:
* Supervisor's name:
* Supervisor's telephone number:
* Supervisor's email address:
* Supervisor's title:
(* information required for students and postdocs)
General research area for which the data will be used:
Date of this agreement:
[ ] I have attached a certificate of completion of a human subjects
protections course.
protections course.

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