Healthcare Survey Data Use Agreement
1. Parties
Discloser Name / Organization
Recipient Name / Organization
Date
2. Purpose of Data Use
Describe the purpose of data use
3. Description of Data
Describe the survey data to be shared
4. Data Handling & Security
Recipient agrees to use the data only for the stated purpose.
Recipient will maintain the confidentiality of the data in accordance with applicable laws and regulations.
Recipient will implement appropriate security safeguards to protect the data from unauthorized access or disclosure.
Data will not be redisclosed to third parties without written permission from the Discloser.
5. Data Retention & Destruction
Describe how and when data will be destroyed or returned
6. Additional Terms
Enter any additional terms or requirements
7. Signatures
Discloser Signature
Date
Recipient Signature
Date