Medical Imaging Anonymized Data Release Agreement

Parties:

Date:

1. Purpose

2. Description of Data

3. Representations and Warranties

The Data has been fully anonymized in accordance with applicable laws and regulations.
The Data does not contain any personally identifiable information.

4. Permitted Use

5. Restrictions

The Recipient shall not attempt to re-identify any individual from the Anonymized Data.

6. Data Security

7. Term and Termination

8. Governing Law

9. Other Terms

Provider Signature:

Provider Name:

Date:

Recipient Signature:

Recipient Name:

Date: