Get Alabama Statewide Cancer Registry Data Request Form

Filling out the Alabama Statewide Cancer Registry Data Request Form is an important step in obtaining necessary cancer data for research purposes. This guide provides clear instructions to help you complete the form efficiently and accurately.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Provide your name in the 'Name of Requestor' field. Ensure that your name is printed clearly.
3. In the 'Location (Room & Building)' field, enter your specific location to facilitate communication.
4. Fill in your 'Phone Extension' to allow for easy contact regarding your request.
5. Input your 'Fax Number' to ensure that documents can be sent to you if necessary.
6. Indicate the 'Topic of Request' to clarify what data you are seeking.
7. State the 'Purpose of Request' to explain the intent behind your data inquiry.
8. Specify the 'Data Due Date' so that the registry understands your timeline for receiving information.
9. Outline the 'Time Period' relevant to your data request to narrow down the information needed.
10. Detail the 'Data Information Needed' to specify the type of cancer data you require for your research.
11. Read the statement regarding the confidentiality of patient information to ensure compliance with ethical standards.
12. Sign and date the form in the 'Signature of Requestor' and 'Date' fields, respectively.
13. Upon completing the form, you can save your changes, download, print, or share the document as needed.

Complete your data request form online today for efficient and streamlined processing.