PIC

Use this form to submit a data use agreement and request access to restricted-access PIC clinical databases. Please be sure to provide all requested information. Submissions that are clearly incomplete, incorrect, or frivolous may be discarded without notice.

If you are a student or a postdoc, please provide your supervisor's name and contact information. If you are not listed in a directory or other easy-to-find page of your organization’s website, please provide the name and contact information of a reference such as a supervisor or colleague. Do not list yourself as reference.

请使用下面的表格来提交PIC的数据使用协议，请确认提供了全部所需信息，如果申请内容不完整、不准确或者不严肃，申请将会被忽略！

我们会通过提交的信息来验证用户身份，如果你没有一个官方网站的个人页面，请添加一个具有这样信息的主管或者同事的信息作为参考。学生或者博士后请提供指导教师的信息！请不要把自己列为推荐人

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By submitting this form, I affirm that if I am granted access to restricted-access clinical databases hosted on PIC:

I will not attempt to identify any individual or institution referenced in PIC restricted data.
I will exercise all reasonable and prudent care to avoid disclosure of the identity of any individual or institution referenced in PIC restricted data in any publication or other communication.
I will not share access to PIC restricted data with anyone else.
I will exercise all reasonable and prudent care to maintain the physical and electronic security of PIC restricted data.
If I find information within PIC restricted data that I believe might permit identification of any individual or institution, I will report the location of this information promptly by email to hmli@zju.edu.cn, citing the location of the specific information in question so that it can be investigated and removed if necessary.
I have requested access to PIC restricted data 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.
I have completed a training program in human research subject protections and HIPAA regulations, and I am submitting proof of having done so.
I will indicate the general purpose for which I intend to use the database in my application.
If I openly disseminate my results, I will also contribute the code used to produce those results to a repository that is open to the research community.
This agreement may be terminated by either party at any time, but my obligations with respect to restricted data from PIC shall continue after termination.

My first (given) name(s):
My last (family) name(s):
Suffix (e.g., Jr.), if applicable:
Telephone number, including country/area code:
Organization:
Job title or position:
Street address:
City:
State/Province:
ZIP/postal code:
Country or Regions:
E-mail:
Official WebPage:
It's important for us to identify the applicant.

Human studies training course (name of course):
Date completed:
Training completion report:

Upload the completion report or certifications from training programs (PDF or image file). The completion report lists all modules completed, with dates and scores. If you would like to submit multiple pages, please combine them into a single pdf file.

* Reference category:
* Reference's name:
* Reference's telephone number:
* Reference's email address:
* Reference's job title or position:

( * information required of students and postdocs, and of anyone—regardless of rank or experience—who is not listed in a directory or other easy-to-find page of his or her organization's website. Do not list yourself as reference! If you do so, your request may be discarded without notice. )

General research area for which the data will be used:

Before submitting the form, please proofread it and correct any evident errors. Watch out especially for entries made by browser auto-complete.

Data use agreement （数据使用协议）