The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

3MpN5t75hP7HwDmwwbfwvzwYu226bPHgmhyAr9

Data Consult Triage Form

Returning?

A A A

Please select the appropriate form for your request:

Data Consult Form: Required for all data requests (except Prostate Core dataset access). The Integrated Diagnostics Program requires a consultation before submitting a data request application. This helps us assess your request and schedule a meeting with the appropriate IDx resource.

Core Dataset Application Form: Use this to request access to the de-identified Prostate Core dataset (updated quarterly, available to UCLA Health Mednet users). No consultation is required.

Choose an option below to continue.

If you have any questions, please reach out to IDx Program Manager Preeti Ahuja at pahuja@mednet.ucla.edu.

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.