If your cohort is defined by AIS, please indicate the AIS code(s) e.g. that have cervical spine fracture. Code 650216” “records – Any other way to define cohort e.g. MDS records from 1 January 2012 to 31 December 2012 from my facility” “all 5. Use of data How will the results be used/disseminated? e.g. results are required to report back to each LHD for planning purposes” “aggregated 6. Consent, privacy and confidentiality Will consent be sought from study participants to use information collected about them? Yes No If Yes, please attach the consent forms and information sheets that will be used How will the privacy of individuals be protected? 7. Data storage and retention Location List all locations where the data will be stored and analysed Storage of data Please describe how the data will be stored during and after the project
If your cohort is defined by AIS, please indicate the AIS code(s) e.g. “records that have cervical spine fracture. Code – 650216” Any other way to define cohort e.g. “all MDS records from 1 January 2012 to 31 December 2012 from my facility” 5. Use of data How will the results be used/disseminated? e.g. “aggregated results are required to report back to each LHD for planning purposes” 6. Consent, privacy and confidentiality Will consent be sought from study participants to use information collected about them? Yes No If Yes, please attach the consent forms and information sheets that will be used How will the privacy of individuals be protected? 7. Data storage and retention Location List all locations where the data will be stored and analysed Storage of data Please describe how the data will be stored during and after the project
ITIM_Data_Request_Form_2017_v4.docx