HIV, STD, and/or Hepatitis C Data Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please use this form to request data on HIV, STDs, (chlamydia, gonorrhea, or syphilis), or hepatitis C from the Iowa Department of Public Health. Read the information below carefully.

In some circumstances, confidential data may be requested from IDPH, but require an agreement for release. All data agreements are coordinated through the Division of Compliance (kelsey.feller@idph.iowa.gov.) Summary data which are not considered implied confidential may be released without an agreement, and can be requested through this form.

The turn around time for most summary data requests is a minimum of two weeks. Data requests for research purposes MUST be approved by the HHS Research and Ethics Review Committee. Information can be found here: https://idph.iowa.gov/PublicHealthData/research-requests

Please do NOT submit Personally Identifiable Information through this data request form. This includes names, dates of birth, address, etc.

Before you submit this request, please check out the Bureau website to view data that are already publicly available:
HIV data: https://idph.iowa.gov/hivstdhep/hiv/data
HCV data: https://idph.iowa.gov/hivstdhep/hep/resources
STD data: https://idph.iowa.gov/hivstdhep/std/resources
County-level chlamydia data: https://tracking.idph.iowa.gov/Health/Sexually-Transmitted-Diseases/Chlamydia-Data
County-level Gonorrhea data: https://tracking.idph.iowa.gov/Health/Sexually-Transmitted-Diseases/Gonorrhea-Data

Questions about this form or data requests should be send to Joyce Mbugua (515) 305-0225 or joyce.mbugua@idph.iowa.gov

Name of Requestor *

Email Address *

Organization Name *

Provide a brief description of your data request. Be specific about what data you are requesting. (For example: "I would like the number of chlamydia and gonorrhea cases by year for 2015-2018 for 18-24 year olds in Polk County." *

By when do you need these data? (Note that the turn around time for most data requests is two weeks.) *

YYYY

How will you use these data you are requesting? *

If you plan to share or release these data publicly, please explain how you'll be sharing data, and the audience: *

Are these data being requested for research purposes? *

Yes (Data requests for research must be routed through the IDPH Research and Ethics Review Committee.)

Thank you for your data request. IDPH will follow up with you regarding this request within three business days.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of State of Iowa. Report Abuse

Forms