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Data access request form

Note: Before completing this form please read the information governance policies and procedures.

Contact Details









Specifics of request

Data requested from NPES previously? *

YesNo


Is present request related to previous request?

YesNo







Declaration by requester


Particulars of research proposal: Data items and analysis plan

I have read and understood the conditions under which this information is being provided by the National Patient Experience Survey. I undertake that the data supplied:

  1. will be used only for the purposes specified in the responses provided on this form.
  2. will not be transmitted or made available in any format, other than as described in this form.
  3. will not be linked to any data not specified in the request.
  4. will be stored in a secure manner and used in a way which complies with the conditions outlined in the Data Access Requests Policy.
  5. will be deleted or destroyed once the specified purpose has been met.
  6. will not be used to contact any individual patients or family members.
  7. will not be transmitted outside the Republic of Ireland unless explicitly permitted to do so.
  8. will not be published in a way that could identify, or be used to identify, individuals or hospitals.
  9. will explicitly acknowledge that the data was provided by the National Patient Experience Survey in any publication.