All researchers requesting the "University Researcher, Single Use" HCUP CA SID, SASD, and SEDD data year 2018 and later through the HCUP Central Distributor must certify and agree to the following additional terms in order to receive CA data.

1. I understand this data may only be used for the project described in the accompanying application. I will not use the single-use HCUP CA SID, SASD, or SEDD databases for any other project or exploratory research.


2. I am an academic researcher employed by a college or University located in the United States or a US territory.


3. My project and intended use of the CA data is directly related to my employment with my academic institution.


4. My project has undergone review by my academic institution's Institutional Review Board (IRB).


5. I will not attempt to link, and will prohibit others from attempting to link, the discharge records of persons in the data set with individually identifiable information from any other source.


6. I will not release or disclose, and will prohibit others from releasing or disclosing, the data set or any part to any person who is not an employee, or member, or contractor of the organization, except with the express written approval of HCAI.


7. I agree to certify the destruction of or return the electronic media/hard copy of the data to HCAI and to certify the destruction of any copies of the patient-level data created from the data provided under this request within three (3) years of the date of this Agreement.
   
   Direct hard copy media returns to:
   California Department of Health Care Access and Information
   Healthcare Data Resources Unit
   2020 West El Camino Avenue, Suite 1100
   Sacramento, CA 95833
   

These terms are indicated and enforced by the California Department of Health Care Access and Information and do not represent AHRQ or apply to any other AHRQ HCUP database or product.

For questions about these California-specific data use restrictions, please contact DataandReports@HCAI.CA.gov.

Signed: ___________________________________________________________ Date:_________________________

Print or Type Name:________________________________________________________________________________

Title: ____________________________________________________________________________________________

Organization:______________________________________________________________________________________

Street Address:____________________________________________________________________________________

City:____________________________________ State:__________________________ ZIP Code:_______________

Phone:__________________________________________ FAX:______________________________________________

Email:_____________________________________________________________________________________________

The information above is maintained by AHRQ and shared with HCAI only for the purpose of enforcement of this Agreement.