Bio-Natural History Project Intake

Please complete for data related studies such as internal chart reviews, data sharing with limited data sets, data collaborations with full PHI.


Specimen collections for internal use, collaborations for specimen sharing, other,

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Dates such as admission, discharge, service, DOB, DOD;

City, state, five digit or more zip code;

Ages in years, months or days or hours.

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Protocols, proposals, databases, contact information, notes, etc.

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