Texas Cancer Registry Confidential Data Request Feasibility Screening Form

To determine whether your data request for confidential TCR data is feasible, complete and submit this form. The Cancer Epidemiology and Surveillance Branch will provide their determination by email, typically within 5 business days. For questions about the form, email CancerData@dshs.texas.gov.

 

PI Information

Study Information

(limit to 1-2 sentences)
Type of Request (Select one)
Provide a brief description of the data that will be linked with TCR, including estimated number of records and data items available for linkage:
Patient Contact Study Description (Complete all follow up questions):
Is the PI a student?:
What types of confidential or potentially confidential data items are being requested? (Select all that apply):

Selection Criteria

(provide range or state "all ages")
(e.g., males only, or specific race/ethnic groups)
(e.g., distant stage at diagnosis, invasive behavior only)