Request Clinical Trial Data

To request data from a clinical trial, please fill out and submit the form below. Please also read our Review Process for Data Sharing.

  • Principal Investigator Information:

  • Research Institution Information:

  • Publication Plans:

  • Research Team

  • Description of Qualifications & Experience (attach CV)
  • Description of Qualifications & Experience (attach CV)
  • Description of Qualifications & Experience (attach CV)
  • Description of Qualifications & Experience (attach CV)
  • Description of Qualifications & Experience (attach CV)
  • By submission of this form I agree to the following:

    • Any research conducted using the data obtained from this request will be submitted for publication according to an SRB-approved publication plan;
    • The data obtained shall not be transferred or shared with any party not identified in this request;
    • There shall be no use of the data for purposes not contained in the request;
    • The requestor and anyone involved in the research must agree that any patient-level data that is shared will be anonymized to protect personally identifiable information and that requestor or anyone involved in the research will not attempt to defeat this de-identification.
  • * Required fields.

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Thank you. Your data request has been submitted.

We will contact you within 30 days regarding your submission. Please contact Purdue’s Medical Services Department with further questions by calling 888-726-7535, option #1.