{"id":958,"date":"2024-03-29T11:31:23","date_gmt":"2024-03-29T10:31:23","guid":{"rendered":"https:\/\/www.francecoag.org\/space-pro\/referral-form-access-to-data-francecoag\/"},"modified":"2026-10-25T15:19:16","modified_gmt":"2026-10-25T14:19:16","slug":"referral-form-access-to-data-francecoag","status":"publish","type":"page","link":"https:\/\/www.francecoag.org\/en\/scientific-research\/referral-form-access-to-data-francecoag\/","title":{"rendered":"Data access request"},"content":{"rendered":"<p>Researchers, healthcare professionals and industry partners can request access to FranceCoag data for a research project. Each request is reviewed by the FranceCoag Scientific Committee.<\/p>\n<div style=\"background-color: #fff3cd; border-left: 4px solid #e6a817; padding: 16px 20px; margin-bottom: 24px; border-radius: 0; font-size: 15px;\">\n<p style=\"margin: 0 0 12px 0;\"><strong>Before you start<\/strong>: the form has 4 steps. Here is the information you will be asked for.<\/p>\n<details style=\"margin-bottom: 8px;\">\n<summary style=\"cursor: pointer; font-weight: bold;\">Step 1: General information<\/summary>\n<ul style=\"margin: 8px 0 0 0; padding-left: 20px; line-height: 2;\">\n<li>Requester\u2019s details (name, e-mail, phone)<\/li>\n<li>Status (within or outside the FranceCoag network)<\/li>\n<li>Research teams involved<\/li>\n<li>Rationale for the request<\/li>\n<li>Source and categories of the data requested<\/li>\n<li>Format of the data delivered and recipient<\/li>\n<li>Funding and planned dissemination<\/li>\n<li>Conflicts of interest and project timeline<\/li>\n<\/ul>\n<\/details>\n<details style=\"margin-bottom: 8px;\">\n<summary style=\"cursor: pointer; font-weight: bold;\">Step 2: Detailed synopsis<\/summary>\n<ul style=\"margin: 8px 0 0 0; padding-left: 20px; line-height: 2;\">\n<li>Project title and acronym<\/li>\n<li>Sponsor and coordinating investigator<\/li>\n<li>Data controller<\/li>\n<li>Rationale, objectives and study design<\/li>\n<li>Population, endpoints and study conduct<\/li>\n<li>Duration, number of subjects and statistical analyses<\/li>\n<li>Expected outcomes and FranceCoag variables required<\/li>\n<\/ul>\n<\/details>\n<details style=\"margin-bottom: 8px;\">\n<summary style=\"cursor: pointer; font-weight: bold;\">Step 3: Attachments<\/summary>\n<ul style=\"margin: 8px 0 0 0; padding-left: 20px; line-height: 2;\">\n<li>Mock-up of the results tables (Word or Excel)<\/li>\n<li>Patient information sheet (Word or Excel)<\/li>\n<\/ul>\n<\/details>\n<details>\n<summary style=\"cursor: pointer; font-weight: bold;\">Step 4: Review and submit<\/summary>\n<ul style=\"margin: 8px 0 0 0; padding-left: 20px; line-height: 2;\">\n<li>Check your information<\/li>\n<li>Submit your request<\/li>\n<\/ul>\n<\/details>\n<\/div>\n<hr \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1902-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1902\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/958#wpcf7-f1902-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1902\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.2.3\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1902-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:1902,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-autre-equipe&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-autre-equipe&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui&quot;}]},{&quot;then_field&quot;:&quot;group-origine-donnee&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-origine-donnee&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;N\\u00e9cessit\\u00e9 de recueil d&#039;informations compl\\u00e9mentaires&quot;}]},{&quot;then_field&quot;:&quot;group-categorie-donnee-autre&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-categorie-donnee&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Autre(s)&quot;}]},{&quot;then_field&quot;:&quot;group-destinataire-donnees&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-destinataire-donnees&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Autre&quot;}]},{&quot;then_field&quot;:&quot;group-financement&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-financement&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui, obtenu&quot;}]},{&quot;then_field&quot;:&quot;group-financement&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-financement&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui, en cours de demande&quot;}]},{&quot;then_field&quot;:&quot;group-valorisation-date&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-valorisation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Diffusion restreinte (r\\u00e9union, m\\u00e9moire, th\\u00e8se)&quot;}]},{&quot;then_field&quot;:&quot;group-valorisation-date&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-valorisation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Communication congr\\u00e8s, colloque&quot;}]},{&quot;then_field&quot;:&quot;group-valorisation-date&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-valorisation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Publication scientifique&quot;}]},{&quot;then_field&quot;:&quot;group-valorisation-text&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-valorisation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Autre&quot;}]},{&quot;then_field&quot;:&quot;group-lien-interet&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-lien-interet&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui&quot;}]},{&quot;then_field&quot;:&quot;group-tableaux&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-tableaux&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui&quot;}]},{&quot;then_field&quot;:&quot;group-notice&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-notice&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Oui&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;,&quot;notice_dismissed_rollback-cf7-5.9.2&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.4&quot;:true,&quot;notice_dismissed_rollback-cf7-5.9.5&quot;:true}}\" \/>\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\" data-transition-effects><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\"><h4>Requester\n<\/h4>\n<p><label>Full name *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label>\n<\/p>\n<p><label>Work e-mail *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/label>\n<\/p>\n<h4>Status\n<\/h4>\n<p><label>Status *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-statut-demandeur\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-statut-demandeur\" value=\"Within the FranceCoag network (entering patient data in the FranceCoag database)\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Within the FranceCoag network (entering patient data in the FranceCoag database)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-statut-demandeur\" value=\"Outside the FranceCoag network \u2013 public institution\" \/><span class=\"wpcf7-list-item-label\">Outside the FranceCoag network \u2013 public institution<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-statut-demandeur\" value=\"Outside the FranceCoag network \u2013 private company\" \/><span class=\"wpcf7-list-item-label\">Outside the FranceCoag network \u2013 private company<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Request from a health authority *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-autorites-sanitaires\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-autorites-sanitaires\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-autorites-sanitaires\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h4>Other research team(s) involved\n<\/h4>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-autre-equipe\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-autre-equipe\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-autre-equipe\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-autre-equipe\" data-orig_data_id=\"group-autre-equipe\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-autre-equipe-yes\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-autre-equipe-yes\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Rationale for the request\n<\/h4>\n<p><label>Rationale *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"txtarea-motivation\"><textarea cols=\"40\" rows=\"10\" maxlength=\"300\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Describe in 2\u20133 lines\" name=\"txtarea-motivation\"><\/textarea><\/span><\/label><br \/>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\" style=\" \">Next<img decoding=\"async\" src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h4>Data source\n<\/h4>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-origine-donnee\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-origine-donnee\" value=\"Available in FranceCoag\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Available in FranceCoag<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-origine-donnee\" value=\"Additional data collection required\" \/><span class=\"wpcf7-list-item-label\">Additional data collection required<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-origine-donnee\" data-orig_data_id=\"group-origine-donnee\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-origine-donnee-etape-2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-origine-donnee-etape-2\" value=\"Available in the medical records\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Available in the medical records<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-origine-donnee-etape-2\" value=\"Requires a dedicated data collection\" \/><span class=\"wpcf7-list-item-label\">Requires a dedicated data collection<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<h4>Data categories\n<\/h4>\n<p><label>Select one or more categories *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-categorie-donnee\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Socio-demographic\" \/><span class=\"wpcf7-list-item-label\">Socio-demographic<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Clinical\" \/><span class=\"wpcf7-list-item-label\">Clinical<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Laboratory\" \/><span class=\"wpcf7-list-item-label\">Laboratory<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Genetic\" \/><span class=\"wpcf7-list-item-label\">Genetic<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Treatment\" \/><span class=\"wpcf7-list-item-label\">Treatment<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-categorie-donnee[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-categorie-donnee-autre\" data-orig_data_id=\"group-categorie-donnee-autre\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>If other, please specify<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"txtarea-categorie-donnee-autre\"><textarea cols=\"40\" rows=\"10\" maxlength=\"100\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"txtarea-categorie-donnee-autre\"><\/textarea><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Data format and recipient\n<\/h4>\n<p><label>Data delivered as *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-modalite-restitution\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-modalite-restitution\" value=\"Aggregated data\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Aggregated data<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-modalite-restitution\" value=\"Individual-level data\" \/><span class=\"wpcf7-list-item-label\">Individual-level data<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Data recipient *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-destinataire-donnees\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-destinataire-donnees\" value=\"The requester\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">The requester<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-destinataire-donnees\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-destinataire-donnees\" data-orig_data_id=\"group-destinataire-donnees\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-destinataire-donnees-etape-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Recipient\u2019s name and position\" value=\"\" type=\"text\" name=\"text-destinataire-donnees-etape-2\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Funding\n<\/h4>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-financement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-financement\" value=\"No funding\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No funding<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-financement\" value=\"Yes, funding obtained\" \/><span class=\"wpcf7-list-item-label\">Yes, funding obtained<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-financement\" value=\"Yes, funding application in progress\" \/><span class=\"wpcf7-list-item-label\">Yes, funding application in progress<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-financement\" data-orig_data_id=\"group-financement\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-financement-etape-2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Type of funding\" value=\"\" type=\"text\" name=\"text-financement-etape-2\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Dissemination\n<\/h4>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-valorisation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-valorisation\" value=\"No dissemination planned\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No dissemination planned<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-valorisation\" value=\"Restricted dissemination (meeting, dissertation, thesis)\" \/><span class=\"wpcf7-list-item-label\">Restricted dissemination (meeting, dissertation, thesis)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-valorisation\" value=\"Conference presentation\" \/><span class=\"wpcf7-list-item-label\">Conference presentation<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-valorisation\" value=\"Scientific publication\" \/><span class=\"wpcf7-list-item-label\">Scientific publication<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-valorisation\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-valorisation-date\" data-orig_data_id=\"group-valorisation-date\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Expected date *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-valorisation-etape-2\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-valorisation-etape-2\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div data-id=\"group-valorisation-text\" data-orig_data_id=\"group-valorisation-text\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-date-valorisation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Type of dissemination\" value=\"\" type=\"text\" name=\"text-date-valorisation\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><i>I agree to comply with the dissemination rules (see the Governance Charter and\/or the Industry Partnership Agreement)<\/i>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-engagement-valorisation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-engagement-valorisation\" value=\"Not applicable\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Not applicable<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-engagement-valorisation\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<h4>Conflicts of interest\n<\/h4>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-lien-interet\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-lien-interet\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-lien-interet\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-lien-interet\" data-orig_data_id=\"group-lien-interet\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label>Please specify *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-lien-interet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Type of conflict of interest\" value=\"\" type=\"text\" name=\"text-lien-interet\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Timeline\n<\/h4>\n<p><label>Project start date *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-calendrier-debut\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-calendrier-debut\" \/><\/span><\/label>\n<\/p>\n<p><label>Requested date for results *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-calendrier-rendu\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-calendrier-rendu\" \/><\/span><\/label>\n<\/p>\n<p><label>Project end date *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-calendrier-fin\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-calendrier-fin\" \/><\/span><\/label>\n<\/p>\n<p><label>Data retention period (in years) *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"number-conservation-donnee\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"1\" max=\"30\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-conservation-donnee\" \/><\/span><\/label><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\" style=\" \">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\" style=\" \">Next<img decoding=\"async\" src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\"><label>Project title *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-titre\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-titre\" \/><\/span><\/label>\n<\/p>\n<p><label>Acronym (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-acronyme\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-acronyme\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Sponsor *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-promoteur\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-promoteur\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Coordinating \/ principal investigator *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-investigateur\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-investigateur\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Other participating centres (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-investigateurs\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-investigateurs\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Data controller *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-responsable-traitement\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-responsable-traitement\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Rationale \/ background *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-justification\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-justification\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Objectives *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-objectifs\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-objectifs\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Study design *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-design\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-design\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Population *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-population\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-population\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Endpoints *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-criteres\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-criteres\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Treatment \/ strategy evaluated *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-traitement\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-traitement\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Study conduct *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-deroulement\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-deroulement\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Study duration *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-duree\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-duree\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Number of subjects *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"number-nombre-sujets\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"1\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-nombre-sujets\" \/><\/span><\/label>\n<\/p>\n<p><label>Statistical analysis plan *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-analyse\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-analyse\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Expected outcomes *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-retombees\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-retombees\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>FranceCoag variables required *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-variables\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-variables\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Statistical analyses requested *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-statistiques\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-statistiques\"><\/textarea><\/span><\/label><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\" style=\" \">Retour<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\" style=\" \">Suivant<img decoding=\"async\" src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h4>Results tables\n<\/h4>\n<p><label>Do you have a results table mock-up to attach? *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-tableaux\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-tableaux\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-tableaux\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-tableaux\" data-orig_data_id=\"group-tableaux\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><i>Please upload your template in Word or Excel format<\/i><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-tableaux\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".docx,.xlsx,.xls\" aria-invalid=\"false\" type=\"file\" name=\"file-tableaux\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h4>Patient information sheet\n<\/h4>\n<p><label>Do you have a patient information sheet to attach? *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-notice\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-notice\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-notice\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"group-notice\" data-orig_data_id=\"group-notice\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label><i>Information for patients specific to this study. Please upload your template in Word or Excel format.<\/i><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-notice\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".docx,.xlsx,.xls\" aria-invalid=\"false\" type=\"file\" name=\"file-notice\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div id=\"cf7sr-6ae216ef32776\" class=\"cf7sr-g-hcaptcha\" data-theme=\"light\" data-size=\"normal\" data-sitekey=\"2c929026-ad14-42d8-b222-52eae9428c84\"><\/div><span class=\"wpcf7-form-control-wrap cf7sr-hcaptcha\" data-name=\"cf7sr-hcaptcha\"><input type=\"hidden\" name=\"cf7sr-hcaptcha\" value=\"\" class=\"wpcf7-form-control\"><\/span>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit request\" \/><div class=\"cf7mls-btns cf7mls-btns-last-step\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-4\" style=\" \">Back<\/button><button type=\"button\" style=\"display: none;\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-4\" style=\" \"><img decoding=\"async\" src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.francecoag.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\" \/><\/button>\n<\/p><\/fieldset><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Researchers, healthcare professionals and industry partners can request access to FranceCoag data for a research project. Each request is reviewed [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":586,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-sidebar.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-958","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Data access request - FranceCoag<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.francecoag.org\/en\/scientific-research\/referral-form-access-to-data-francecoag\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Data access request - FranceCoag\" \/>\n<meta property=\"og:description\" content=\"Researchers, healthcare professionals and industry partners can request access to FranceCoag data for a research project. 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