Data request form | CSS Institut

General information about the project

Project title* (max.. 150 characters)

Research question* (max.. 150 characters)

Short description of the project* (max.. 1500 characters)

Identification strategy* (max.. 500 characters)

Method* (max.. 500 characters)

Title

Name*

Last name*

Affiliation*

Street*

ZIP Code*

Place*

Country*

E-Mail*

Telephone*

Coauthors with data access*

Information about all coauthors*

Data specifications

From*

To*

Variable selection

Restrictions / Sample selection (max.. 200 characters)

Further information

When would you like to start the project?

Are or were data requested from other health insurers?*

Please list the involved health insurers.* (max.. 200 characters)

Does the project require written consent from patients?*

Is the project funded by third parties?*

Please specify* (max.. 200 characters)

Do you need a "Letter of Intent" for a funding application?*

Is there anything else you would like to share with us?