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UCLA ISAP DMC Data Cut Request Form

Project

PI

Designate

When possible

ASAP

By [date] (one cut only, specify date below)

Scheduled (multiple cuts)

Frequency:

Processing time frame:

Weekly

Monthly

Quarterly

Internal to ISAP

External to ISAP (Subject to HIPPA policies/data sharing agreements)

Data cut will be used:

DMC SQL Server

Other ISAP server, PC, or laptopp (specify)

FTP site (specify)

CD/DVD/Other removal media

Location of data (if known)

Questionnaire(s) needed:

"Raw" data (as-is, no post-data collection manipulation)

"Flat" file (one record per subject, from multipe base tables)

"Stacked" file (multiple records per subject, from multiple base tables)

Other (specify)

Data structure requested

ASCII, DBF

Excel

MS Access

SAS

SPSS

Other (specify)

Format needed

Yes

No

De-Identified

Direct SQL access (ODBC or ADO)

ISAP internal network

DMC web site

VPN location

FTP site

CD-ROM/DVD-ROM

E-mailed (data must be de-identified)

Data transport method

e-Mail address:

Screening

Timepoint(s) needed (select all)

Baseline

In-treatment

Discharge

Follow-up

Single timepoint survey

or specify

(IF YES, Please provide a list Personal Identifier variables to be modified, removed or other processing)

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