Health Data Use Ethics Review Application

1. Project Information

Project Title Brief Description Principal Investigator / Project Lead Organization / Affiliation Contact Email

2. Data Details

Data Source(s) Type(s) of Data Volume of Data Data Identifiability Identifiable De-identified Anonymized

3. Purpose and Use of Data

Project Objectives Intended Use of Data

4. Data Security & Management

Data Storage Method Access Controls Data Retention Period

5. Legal & Ethical Considerations

Consent Process Risk Mitigation Strategies

6. Additional Information

Additional Notes