Clinical Data Sharing Request Form

Check to confirm your CV has been uploaded in the Attachments section below

Check to confirm the COI form has been uploaded in the Attachments section below

You may also add Protocol Number or NCT Number

Include details as to how this research will contribute to an unmet medical need or bridge a gap in medical knowledge

Include any hypotheses that will be tested. You can upload your research plan in the Attachments section below

Provide the names of all team members who will require access to the data for analysis

Check to confirm the COI form has been uploaded in the Attachments section below

Check to confirm that CVs for the research team have been uploaded in the Attachments section below

“You understand and agree that any personal information you provide through this form will be processed by Jazz Pharmaceuticals in accordance with Jazz Pharmaceuticals’ Privacy Statement (https://www.jazzpharma.com/privacy-statement/ ). Such personal information will be processed by Jazz Pharmaceuticals only for the specific purpose of reviewing your request. Please do not provide any sensitive personal information.”