Request for Aggregate Data from the Nova Scotia Atlee Perinatal Database

Use this form to send a data request to RCP.

Date of application: *

Date data required: *

Name: *

Name of data requester

Position: *

Your position within your organization

Organization: *

The name of your organization.

Mailing Address: *

Telephone: *

Fax:

E-mail: *

Enter an e-mail address for us to contact you regarding your request. A copy of your application will be sent to this address.

Description: *

Description of question / data requested

Number of years requested: *

The number of years worth of data you are requesting

Report each separately?: *

Yes

Report each year's aggregate separately?

Include Total: *

Yes

Include a total for all years?

Year type to report by: *

Calendar

Fiscal

Report data by calendar year or fiscal year?

Place type to report by: *

Place of residence

Place event occurred

Report data by
Place of residence (e.g., breastfeeding rate for residents of x)
Place event occurred (e.g., breastfeeding among those who gave birth in x)