Request to Re-identify i2b2 Cohorts

Please complete the following survey to submit a request for a re-identified i2b2 dataset. This form should be completed AFTER the following items are complete:

IRB approval and letter in hand for the patient cohort/study in question
TMC Research Administration has granted the project approval (for information on this, go to http://med.umkc.edu/ora/conducting-research-at-tmc/ or email HSDResearch@umkc.edu)
The patient cohort query should be placed in the "SHARED" folder found in the workplace window in the de-identified i2b2 with the query name description--PI last name. For example, "asthma/albuterol/purple clinic--Smith" You can rename queries by right-clicking and renaming.

Failure to complete these items before requesting can result in delays for the return of your information.

Timestamp

What is your first and last name?

* must provide value

What is your institutional email address?

* must provide value

Are you the principal investigator on your study?

* must provide value

Yes

reset

What is the principal investigator's first and last name?

* must provide value

What is the principal investigator's institutional email address?

* must provide value

What is your IRB number?

* must provide value

Please attach your official IRB documentation here:

* must provide value

Upload file

Please attach your TMC research administrative approval form:

* must provide value

Upload file

Please attach a document detailing exactly which identifying information needs to be re-attached to your cohort. Include any unique codes for each identifier if relevant. This document does not need to be extensive but should be exhaustive enough to make sure our analysts know what information to return to you. If unclear, we'll need to contact you and this will delay the return of your data.

* must provide value

Upload file

Please optionally include any secondary documents:

Upload file

I have placed my query to be re-identified in the "SHARED" folder on the de-identified i2b2 web client.

* must provide value

True

False

reset

What is the name of the query in the SHARED folder?

* must provide value

Please optionally provide any additional or clarifying information for your submission.

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.