CPRD Initial Extract/Analysis Request Form

Name of Research Group Nominee: *

First Name

Last Name

Date

MM

DD

YYYY

Work package *

Please indicate which work package the requested extract/analysis the study falls into:

Work package 1 – Extract, Approvals, Full Analysis and Report

Work package 2 – Extract, Full Analysis and Report

Work package 3 – Extract data set only

Request for exemption of fees

The first two extracts for each research group will be free to investigators at University of Leicester per year. The second extract will only be provided after the first study is completed, i.e. the final draft of the paper is ready. If two extracts are not taken in the first year, they will lose the free extract (i.e. they cannot be accumulated). Studies that form part of CLAHRC East Midlands (after assessment by the LRWE team) or student projects (after assessment by the LRWE team) will be also be free (Work package 3 only). Subsequent extractions and analyses will require a fee.

This study is the first or second request (work package 3 only) from the Investigator’s research group this year and is exempt from fees.

This study is a student project (work package 3 only). We are requesting that fees are waived for this study.