If this study requires patient identifiable information, describe in full the reasoning for this request below. Include how the data will help the study and how not having the data will impede the study. Legal basis powers Present your legal basis for requesting Section 251 patient identifiable data. Check all that Patient consent apply. Care Act 2014 requirement section 122 Other, please specify below: Upload the evidence/documents that back up your legal bases. These must include a copy of the research project DPIA and system security policy if you are requesting patient/sensitive data. Frequency One-off Indicate how often this data will be Periodic monthly – required. Periodic quarterly – Periodic annually – Ad hoc irregular dissemination – Continuous Other, please specify below: Linked data requirement Yes Does this study include links with other No data sets? If YES, outline the purpose of the required data link(s) below: Does the applicant and/or anyone Yes associated with this study have No access to other linked data sets? If YES, provide further details including a description of the data sets, any patient identifiable data, the sources and/or methods of data collection and how they are used with the requested data below: Dataset Classification of Data minimisation Legal basis for data efforts dissemination set
If this study requires patient identifiable information, describe in full the reasoning for this request below. Include how the data will help the study and how not having the data will impede the study. Legal basis Present your legal basis for requesting patient identifiable data. Check all that apply. powers Section 251 Patient consent Care Act 2014 requirement section 122 Other, please specify below: Upload the evidence/documents that back up your legal bases. These must include a copy of the research project DPIA and system security policy if you are requesting patient/sensitive data. Frequency Indicate how often this data will be required. One-off Periodic – monthly Periodic – quarterly Periodic – annually Ad hoc – irregular dissemination Continuous Other, please specify below: Linked data requirement Does this study include links with other data sets? Yes No If YES, outline the purpose of the required data link(s) below: Does the applicant and/or anyone associated with this study have access to other linked data sets? Yes No If YES, provide further details including a description of the data sets, any patient identifiable data, the sources and/or methods of data collection and how they are used with the requested data below: Dataset Classification of data set Data minimisation efforts Legal basis for dissemination
Data%20for%20Research%20Application%20Form%20%28V3%29%2008.2018.docx