| هـ |
تجريبي
الأخبار

1. Requester Information

Name
Institution
Job Title
Country
City
Address
Mobile
Email

2. Data Items Requested

Patient Population
Cancer Site(s)
Histology
Time Period
Variables

3. Purpose of Request

Purposes
Comment
Requests affirmation statement

I hereby, the requester of above data affirm that the data given to me by SCR will be treated with utmost confidentiality in relation to patient’s identity. I also affirm that the data given to me will not be presented or published by me or my collaborators as an original work but rather can be cited in my presentations and/or publication with acknowledgment of the SCR.

I Agree
Conditions of approve to release cancer data from Saudi Cancer registry SCR.:

1.Fill in the form through our website completely.
2.Explain the purpose of request.
3.If the data are required for a scientific research, your request should be supported with an official approval for your research from an authenticated scientific entity Example: Institutional Review Board Approval(IRB) /Research Ethics Committee Approval (REC).
4.You also have to attach an authentication letter from your approved work/hospital/university charitable organization which you come from defining your name as a student or employee also containing your contact information for any inquiries. (In case you were a scholar you must attach a letter from the Saudi Arabian Cultural Mission, SACM.)
5.The data requester must mention SCR. as the source of information whether in scientific research, presentation or any other illustration or information material, means or other purpose.
6.For confidentiality purposes data will not contain personal information or affect the patients privacy.
7.Data must not be given or requested (through any employee of SCR.) to anybody or entities without a written approval from SCR. administration.
8.Approval of SCR. administration.

Attachments