HIV AIDS Data Request Form
IMPORTANT DATA CONFIDENTIALITY NOTICE:
After you understand and agree to the notice below you will be directed to the data submission form.
1. The Department of Health's designated data requests reviewer(s) will review your data request to ensure that your data request is processed in the most appropriate Epidemiologic manner AND the confidentiality and security of the HIV/AIDS reporting system is preserved in accordance with CDC guidelines and Act 148(1990) of Pennsylvania.
2. Only aggregate data can be released to the public and this is done in a manner that prevents the possibility of individually identifying information from being released.
3. Requests for Collaborative HIV Epidemiology Analyses with the Department of Health:
a) Requests for special non-independent Collaborative HIV/AIDS Epidemiology Analyses within the Department of Health may be submitted through this data request form and will be processed in accordance with the Department's established framework & procedures for Collaborative HIV Epidemiology Analyses to be provided to requesters upon receipt of such requests. All non-independent Collaborative HIV Epidemiology Analyses are accorded the status of internal Department of Health projects and shall always remain under the authority of the Department of Health from conception to conclusion to ensure that data confidentiality is preserved in ALL instances. A limited number of such requests are accepted and approved in accordance with Department priorities. b) All other requests by ANY researchers who do not have role-based access, for purposes of conducting independent collaborative research analyses on Department of Health registries, may be referred to the Department of Health IRB for review to ensure that data confidentiality is preserved in ALL instances.
4. The data that will be provided to you may only be used for the purpose stated by you and approved by the State for this data request.
5. The data that will be provided to you may not be released or publicly distributed in any form for reasons other than those stated and approved for the request to any party without the express written permission of the State HIV/AIDS Epidemiologist.
6. If so indicated by the State, you agree to submit data products that you may develop to the State for final review and approval for public release before any public distribution can be made. You also agree to acknowledge in any release of the data products, the source of the data that may be provided to you as follows:
"Source: HIV/AIDS Epidemiology Section,
Bureau of Epidemiology - Division of Infectious Disease Epidemiology,
Pennsylvania Department of Health [Year of Data Release]".
7. You understand and agree that your use of the citation of the data source does not imply approval of any interpretations or presentation of the data that you may make.
8. By submitting this request you acknowledge, accept and agree to abide by the conditions of use of the data as indicated herein or any other additional conditions that the State may specify to you.
I have read, fully understand and agree to the confidentiality notice above:
Data Request Form is not yet available, please email firstname.lastname@example.org to send your data requests.
If you have questions, please email email@example.com or call 717-783-0481.