All-Payer Claims Database (APCD) Data Request Form

Please indicate whether you would like access to the MedInsight platform:*

YesNo
Click here to download the APCD New User Form.

Please fill in the required information and submit your completed form to the provided point of contact below.
Meredith Olson

Data Training Coordinator

meredith.olson@vdh.virginia.gov
If you are interested in receiving a dataset or custom report, please email APCDsupport@vhi.org.
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Data Applicant Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Organization Name*
Organization Type*

ResearcherGovernment AgencyHealthcare ProviderNonprofit OrganizationOther
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Data Security
Please provide the name of the organization that will host and manage the data (if different than the requestor).
How and where will the data be located physically?*
Server Type*

CloudLocalOther
Provide the name, title, and organization of all individuals that will be allowed to have access to the data.
Has your organization experienced a data breach in the past?*

YesNoNot Sure
Please describe the incident.*
What policies, if any, were implemented in response to the incident described?*
What policies and procedures are in place to ensure the data will be protected while stored on server(s)? (e.g., data encryption, user authentication process, locked offices)*
Does your organization have an information security certificate (e.g., SOC 2, HITRUST)?*

YesNoNot sure
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Data Destruction
How long will you need access to the data for?*

One yearTwo yearsThree yearsOther
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Additional Information Required
In order to complete your application, please fill out the Data Dictionary form to the best of your ability and upload below.
Data Dictionary*

Browse Files

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Please upload any supplemental files (e.g., abstract, IRB approval letter, security plan) below.
Supplemental files

Browse Files

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If you have any questions while completing this form, please email APCDsupport@vhi.org.
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Data Applicant Information