Patient Registry Data Request Review Form

Patient Registry Data Request Evaluation

Use this form to evaluate a data use request for the Dizziness, Vertigo, and Imabalance Patient Registry. Keep in mind the limited staff time available to pull and organize the data being requested.

Reviewer's Name(Required)
Copy/paste from data use application
Is the research question or purpose clearly defined?(Required)
Can you understand what the applicant wants to learn or accomplish with the registry data?
Is the proposed project relevant to vestibular patients and VeDA’s mission?(Required)
Does it have reasonable potential to increase understanding of vestibular disorders, improve diagnosis or treatment, improve patient care or quality of life, or otherwise benefit the vestibular community?
Is the proposed use of the registry data scientifically appropriate?(Required)
Does the project appear to be a reasonable use of the data, and can the research question reasonably be addressed using the data being requested?
Does the research team appear qualified to conduct the proposed project?(Required)
Consider the investigators’ clinical, research, statistical, or other relevant expertise.
Is the amount and type of data requested appropriate for the stated purpose?(Required)
In other words, are they asking for data they actually need, rather than requesting more registry information than the project appears to require?
Are patient privacy and data security adequately protected?(Required)
Consider the proposed storage, access, security safeguards, IRB oversight, and potential risk of identifying individual registry participants.
Does the project appear to respect the interests of registry participants?(Required)
Consider whether participants could reasonably view this as an appropriate use of information they contributed to VeDA’s registry.
Are there any significant concerns about conflicts of interest or commercial use of the data?(Required)
Consider the project’s funding, the applicant’s organizational affiliation, commercial interests, and whether the findings could primarily be used to promote a product or service rather than advance knowledge or patient care.
Please identify any scientific, ethical, privacy, patient-interest, commercial, reputational, or other concerns.
If yes, please explain.
A few sentences are sufficient.
What is your recommendation?(Required)
Would you be comfortable explaining to a registry participant why VeDA approved this use of their data?(Required)
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