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@@ -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 [email protected], 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. | ||
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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: | ||
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Name of human studies training course completed: | ||
Date completed: | ||
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* Supervisor's name: | ||
* Supervisor's telephone number: | ||
* Supervisor's email address: | ||
* Supervisor's title: | ||
(* information required for students and postdocs) | ||
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General research area for which the data will be used: | ||
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Date of this agreement: | ||
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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. |