Clone of NPDS Non-Member Data Request Form

  • National Poison Data System®

    Non-Member Data Request Form (DRF)
  • Which of the following describes your affiliation with America's Poison Centers?*
  • Are you requesting this data on behalf of or in collaboration with a third-party?*
  • Will the Poison Center or any other party be receiving any funding for data or research associated with this request?*

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    You may save and continue completing this form later by selecting "Save" at the bottom of each page. *If you exit this browser without selecting "Save", all responses will be lost.

     

    NEXT STEPS:

    • Once this form is complete and reviewed by America's Poison Centers, it will be used to determine search parameters and costs (if applicable).
    • All requests are subject to approval by America's Poison Centers internal reviewers prior to establishing a Data Licensing Agreement (DLA) and Data Use Agreement (DUA).

     

    Questions? Contact DataRequests@PoisonCenters.org.

  • This form is intended for the following types of requestors:

    • Those NOT collaborating with sponsoring Poison Center(s).
    • Those collaborating with Poison Center representative(s) on a funded request.
    • Representatives from Poison Center(s) who are receiving funding for a request.
    • Representatives from a federal agency under an existing contract with America's Poison Centers.

     

    To proceed, please click here to complete a Member request:

    Member Data Request

     Note: Poison Center Director's approval is required.

     

    Questions? Contact DataRequests@PoisonCenters.org.

  • Is this a request to update a previously fulfilled data request you submitted?*
  • Date of Previous Request Submission*
     / /

  • SECTION A: REQUESTOR INFORMATION

  • Date:*
     / /
  • Format: (000) 000-0000.
  • Role in Research Project (select all that apply):*
    • Collaborators 

    • Collaborator #1:
      Name: *             
      Organization: *  
      Title/Position: *       
      Role in Research Project: 
        
         
        
         
         
        
      *       

    • Collaborator #2:
      Name: *             
      Organization: *  
      Title/Position: *    
      Role in Research Project:
         
         
         
         
         
         
      *                                                     

    • Collaborator #3:
      Name: *             
      Organization: * 
      Title/Position: *   
      Role in Research Project:
         
         
         
         
         
         
      * 

    • Collaborator #4:
      Name: *             
      Organization: * 
      Title/Position: *     
      Role in Research Project:
         
         
         
         
         
         
      * 

  • SECTION B: DATA REQUEST DESCRIPTION

    Please be as specific as possible when completing this section, as these responses will be used to determine whether your request is approved by reviewers.
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  • SECTION C: DATA QUERY PARAMETERS

    PART I: GENERAL

  • PLEASE NOTE:

    All National Poison Data System® (NPDS) data reported by America's Poison Centers® during the year in which the exposures occur is considered preliminary because it is possible that a Poison Center may update a case anytime during the year if new information is obtained. Changes occur in only a small number of cases each year. In the fall of each year the data for the previous year is locked, and no additional changes are permitted.

  • 1. Date Range (multiple improvements were made in 2000 - comparisons to data prior to 2000 require special consideration):
    Pick a Date* to   Pick a Date*    

  • 1. Date Range for data extension (multiple improvements were made in 2000 - comparisons to data prior to 2000 require special consideration):
    Pick a Date* to   Pick a Date*    

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  • 2e. Substances - If requesting more than one substance, include:*
  • 2f. Substances - Indicate preference:*
  • 5. Case Status:*
  • 6. Transferred Cases (between Poison Centers):*

  • SECTION C: DATA QUERY PARAMETERS

    PART II: Exposure Cases
  • 1. Do you require exposure cases?*
  • 2. Patient species?*
  • 3. Patient age:*
  • Select estimated age categories (years):*
  • 4. Exposure Reason:*

  • Select Exposure Reason Type(s):
    Unintentional: An exposure resulting from an unforeseen or unplanned event such as a child gaining access to a toxic substance when it is obvious the child did not realize the danger of the action.
      
       
     
       
       
       
       
       
    Intentional: A purposeful action that results in an exposure.
       
      
       
      
    Other:
      
       
      
    Adverse Reaction:
       
       
     
    Unknown:
    *

  • 5. Associated Medical Outcome:*
  • Select Associated Medical Outcome Type(s):*
  • 6. Do you require the inclusion of Poisindex® product ID codes and product names in the dataset?*
  • Type(s) of product identifiers:*
  • Are you requesting this data as a representative from a federal regulatory agency under a contract with America's Poison Centers?*
  • Does the requesting organization own the brand(s) included in the product identifiers request?*
  • Do you have a Letter of Authorization from the brand owner(s)/representative(s)?*
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  • 7. Do you require the inclusion of geographic identifiers in the dataset?*
  • Type(s) of geographic identifiers:*
  • Are you submitting this request on behalf of a public health authority (CDC, NIH, HRSA, CPSC, SAMHSA, FDA, OSHA, DEA, federal, state, and tribal public health agencies, state cancer registries, vital statistics departments, anyone performing public health functions under a grant of authority from a public health agency)?*
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  • SECTION C: DATA QUERY PARAMETERS

    PART III: INFORMATION CASES
  • 1. Do you require information cases? (CASE(S) WITH A LACK OF AN IDENTIFIABLE EXPOSED PERSON)*
  • 2. Type of information case categories (select all that apply):*
  • 3. Select desired information case categories:*

  • SECTION D: DATA OUTPUT TYPE

  • Data Output Type (select all that apply):*
  • Case Listings file format:
  • Will you be generating and providing table shells?*
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  • SECTION E: FATALITY ABSTRACT REQUEST

    All exposure related fatalities are listed in Table 21 of America's Poison Centers Annual Reports. Synopses of a select number of fatalities are published in an appendix to the Annual Reports (https://poisoncenters.org/annual-reports).

  • 1.Date Range (Fatality abstracts for the current and past year will not be provided until the NPDS Annual Reports for those years are published (i.e. 2025 will not be available until January 2027):
    Pick a Date* to Pick a Date*    

  • Please update the date range above if you do not wish to wait to receive abstracts that are not currently available (2025 and beyond).

  • 2. Would you like to include the same substances listed previously in Section C?*

  • REVIEW DISCLAIMER & SUBMIT

  • The following disclosure statement on America's Poison Centers data must be included in all publications referencing America's Poison Centers data.

    America’s Poison Centers® maintains the National Poison Data System® (NPDS), which houses de-identified records of self-reported information from callers to the country’s Poison Centers (PCs). NPDS data do not reflect the entire universe of U.S. exposures and incidences related to any substance(s). Exposures do not necessarily represent apoisoning or overdose and America’s Poison Centers is not able to completely verify the accuracy of every report. NPDS data do not necessarily reflect the opinions of America’s Poison Centers.

     

    To complete this data request, please select Submit. 

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