Before proceeding, please read the following carefully.
  • This form should be completed by an Emory faculty member, staff member, or student.
  • All required fields are noted with a red asterisk*. You will not be able to advance within the survey or submit your request until the required fields have been completed.
  • At the end of this survey, if you request access to sensitive information through the IT Data Solutions department in the Office of Information Technology, you may be asked to sign a Terms of Data Use.

Please study the following to determine which type of dataset you are requesting.
  • Emory HIPAA policies regarding datasets containing protected health information (PHI) and de-identified datasets: in Section C
    • Please ensure IRB approval before requesting any Individually Identifiable Health Information for research purposes.
    • If you are requesting data for research, depending on the type of dataset requested, you may be required to upload copies of your study protocol and IRB approval letter.
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