Collaboration Request Form

Thank you for your interest in collaborating with BESTMED. Please fill out this form and we will get back to you.

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Requester/PI first and last name: *

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Are you affiliated with any of BESTMED partner site listed below:NoneCarelonBaylor Scott & WhiteCleveland ClinicGreater Plains CollaborativeUniversity of lowaAllina HealthIntermountain HealthcareMarshfield ClinicMedical College of WisconsinUniversity of MissouriUniversity of UtahHumana (PRACnet)Mass General Brigham

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Type of requestLetter of Support OnlyAggregate Counts (Prep-to-Research/Fessability/Applications)Deidentified Encounter Level Data SetLimited Data SetPatient Community Engagement AssessmentOther

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BESTMED site engagement:

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