This form is to be used by PelEX participants & partners to request data. PelEX collects real-time electronic health record data for permitted use categories by HIPAA (i.e. treatment, payment, and health care operations). Each request will be thoroughly reviewed by PelEX staff and the HIPAA Privacy and Compliance Officer. The request may also be reviewed by a PelEX Participant, PATH Board of Directors or LPHI governance. Please be as descriptive as possible to facilitate review of your request. You may be contacted for additional information as PelEX reviews your request. PelEX can only fulfill requests that comply with HIPAA and applicable law. If your request is approved, PelEX will provide a proposal letter for data services and initiate any needed Business Associate Agreements and/or Data Sharing Agreements.
