Please review the PCG Data Use and Publication Policy before submitting a data use request.

Please note that DICOM-RT files in our EDC include data from July 2017 to the present. Requests for DICOM-RT data prior to this date will be considered a special project with a timeline of at least 90 days. PCG is not able to guarantee that all files can be obtained from the institutions. If medical records may be needed for your project, please contact PCG directly at hq@pcgresearch.org or call the office at (630) 836-8668. Further information will be provided.

The PCG Data Use Form should list all investigators working on the project.

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* 1. Date of the Request (Today's date)

Date

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* 2. Target date of Presentation/Journal/Abstract/Poster Submission:

Date

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* 3. Requester's Name

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* 5. Requester's Institution

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* 6. Are other participants working on this project with you?

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* 7. If you answered "Yes" to question 5, list Participants (Name, Email, and Institution)

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* 8. Is this a NEW Data Use Request? Or is this a request for an Update for a previously submitted Data Use Request?

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* 9. If this is an UPDATE to a previously submitted data use request, please explain what is currently being requested, including the original data use request DATE, NAME of the original requester, description of the original request, and detailed description of the requested UPDATE.

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* 10. PCG Registry, REG001-09 Evaluation Tracking Project: A Prospective Chart Review of Patients Treated with Radiation Therapy, disease site you are requesting permission for. All data collected on the PCG case report forms will be included unless otherwise specified.

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* 11. What Institutions are you requesting data from?

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* 12. If you are requesting data from a specific institution or institutions (answered in question #9), list specific Institution(s).

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* 13. Goal of the Project

Provide a detailed overview of the project.

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* 14. This project will be used for (please select all that apply):

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* 15. What case report form or forms are you requesting data from?

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* 16. I verify that I have read and agree to abide by the current PCG Data Use and Publication Policy.

You will receive an email letting you know that your request has been received.

*Note: The approximate time of delivery for Data Use Requests is 1-3 months. Data Update Requests will take longer. While we strive to collect comprehensive data for the PCG registry, not all data may be available from all sites. We will make every effort to obtain as much data as possible, but PCG cannot guarantee that all data for all forms can be obtained from all sites participating in REG001-09.

*PCG may ask you to submit a new data use request if data is obtained from PCG and not used within one year.

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