Home / OBI Data Request Form Data Request Form Your email address(Required) Your Full Name(Required) First Last What OBI hospital are you affiliated with?(Required)Hospital 1Hospital 2Hospital 3What is your role with OBI?(Required) Clinical data abstractor (CDA) Nurse at OBI hospital Provider at OBI hospital OBI core faculty member Other Please tell us your role with OBI: Are you requesting a custom report or a dataset?(Required) Custom Report Dataset Would you like us to include a comparison to the collaborative average?(Required) Yes No Please describe your report request:Select time period for your report request:What format would you like your report in?(Required) Table Graph Both table and graph What is your preferred method to receive your completed report?(Required) DropBox Secure email Please provide a brief description of your project including the goals:(Required)Start Date(Required) End Date(Required) Are you requesting a limited or de-identified dataset?(Required)How to choose your dataset type Research QI Please upload your IRB approval(Required)Accepted file types: pdf, Max. file size: 100 MB.Is your dataset request for the purpose of research or quality improvement (QI)?(Required) PLEASE NOTE: OBI will use this to determine which variables you can and cannot receive, regardless of what is requested in the variable selection file Limited De-identified Please upload your completed variable selection file:(Required)Variable selection fileAccepted file types: csv, xlsx, xls, xlsb, xlsm, xml, dbf, Max. file size: 100 MB.What is your preferred due date for this request?(Required) Is there anything else you would like us to know about your request?(Required)OBI Data Request Policy Acknowledgment(Required) I have read and understand the terms of the OBI Data Request PolicyOBI Hospital Data Collaborative Agreement and Data Use Agreement Acknowledgement(Required) I attest that any publication(s) resulting from this data will meet the standards per the OBI Hospital Data Collaborative Agreement and Data Use Agreement to ensure contextual non-identification of patients, hospitals, and/or medical professionals.Data use Agreement Acknowledgment(Required) I will only use the data for the purposes as described in this data request form and also in the Data Use Agreement if needed.