analyticsCodman
arrow_drop_down

Registration Form

Through this request form, you can apply for Codman Connect for yourself and collaborating healthcare institutions.

Once MRDM has received this completed request form, MRDM will draft a contract for the participating healthcare institutions. After all participating institutions have signed this contract, Codman Connect will be activated.

    Your Details

    Request Connect for

    Codman Indicators

    Select registration(s)

    (this choice applies to all previously selected registrations)

    Codman Exploratory

    Select registration(s)

    When you request Connect for Exploratory, all results from Codman Exploratory are shared. This includes both transparent and non-transparent data. Additionally, all filters (except for clinician filters) are available for both your own and shared data. If 10 patients or fewer remain for a collaborating healthcare institution, the result will not be shown.

    Time Period

    How long do you want to use Codman Connect? After this period, the functionality will automatically stop. Your regular Codman dashboards will remain active. If nothing is entered, a default of 3 months will be assumed. Codman Connect will be activated within 2 weeks after receiving all signed DocuSign contracts.

    Participating Institutions

    For which healthcare institutions do you want to activate Codman Connect? All institutions will receive identical functionality according to the wishes outlined in this form.

    Required Information:
    1. Names of the healthcare institutions participating in the Codman Connect collaboration (including your own institutions)
    2. Names and email addresses of the contact persons within the healthcare institutions who will ensure that the Codman Connect contract is signed by an authorized person

    Note: all institutions with which you want to share data must be explicitly listed below, including the contact person. Without this information, the request cannot be processed.

    Example: DICA Hospital, Frank de Jong, fdejong@dica.nl; Medical Center MRDM, Ronald Jansen, rjansen@mrdm.nl

    This could include an institution that does not want to participate in a certain registration or for a shorter time period

    • By filling in this form, you consent to the use of this data by MRDM and DICA.
    • The purpose of using this data is limited to communication regarding participation in the registration(s) for which there is a collaboration between your organization and MRDM and DICA.
    • The individuals known through this document can at any time request correction, deletion, or access to the data held by the Service Desk.
    • The data will not be shared with third parties and is stored at MRDM as long as a collaboration exists between your organization and MRDM and DICA.
    • MRDM is ISO 27001:2013 and NEN 7510:2011 certified, ensuring the secure processing of personal data.

    Service Desk

    If you have any questions, we are here for you.
    Call or email us at the phone number or email address below.

    servicedesk@mrdm.nl
    Or call +31 88 57 000 10