February 2013
Integrating Mental and Physical healthcare: Research Training and Services
(IMPARTS)
Research Data Transfer and Confidentiality Agreement
This agreement is between the IMPARTS project on behalf of KING’S COLLEGE HOSPITAL
NHS FOUNDATION TRUST/GUY’S AND ST THOMAS’ FOUNDATION TRUST and
NAME/INSTITUTE. It refers to the anonymised dataset provided by the IMPARTS project to
NAME on DATE for the purposes of data analysis as specified by the IMPARTS Research
Database Oversight Committee.
I, the undersigned, understand that KINGS COLLEGE HOSPITAL NHS FOUNDATION
TRUST/GUY’S AND ST THOMAS’ FOUNDATION TRUST (1) retains all intellectual property
rights in the data, (2) has sole publishing rights, and (3) has control over the content of any
document that may result from these analyses.
I agree that I will not pass the data, or the results of the data analysis, or disclose any
information relating to the data to a third party.
I confirm that I will return all copies of the dataset along with all documents (electronic and
paper) relating to the dataset on completion of the work or immediately upon request.
I agree that I will not publish the data or any analysis relating to it. I will make every effort
to ensure that the results are reported in such a manner that individuals cannot be identified.
I agree to hold the data confidentially and securely in accordance with Trust policies.
Signed by NAME
Signed ______________________________________
Name _______________________________________
Date ________________________________________
Signed on behalf of the IMPARTS Project
Signed ______________________________________
Name _______________________________________
Position _____________________________________
Date ________________________________________