Disclosure of personal data

Personal data disclosure form

Internal data controller/contact person (faculty, department/centre, name, phone no.)*

Internal data controller/ contact person - AU email*

Contact information of department head (name, AU email, phone no.)*

I confirm that the department head has approved disclosure of personal data*

Yes

AU's file no. of the research project from where you want to disclose personal data (can be found in the statement that the researcher received in connection with the internal notification of the project)*

Title of the research project title from where the data is disclosed from.*

Receiver (data controller) who receives the disclosed data - e.g. university or research institution (name, address, name of contact person, phone no. and email)*

The recipient's project title*

Elaborate "other"

Describe/delimite the group(s) of persons who the data concerns (e.g. women aged xx who has received a certain treatment)*

Confirm by ticking the boxes that the internal data controller/contact person at AU has received a written statement from the receiver that*

the personal data is specifically necessary for the receiver's research projekt.

the personal data will be used solely for statistical or scientific purposes.

the personal data will not be passed on to a third party.

the dissemination of the results will take place in a way that does not reveal the identifies of individuals. the personal data will be erased, anonymised or destroyed at the end of the study so that it is not possible to subsequently identify individuals whose data have been used or that the personal data will alternatively be archieved under the rules laid fown in the legislation on archieves.

Is biological material, e.g. blood samles, disclosed?*

yes

Personal data will be passed on to treatment outside the territorial field of application (e.g. The U.S.)*

Yes

The disclosure of personal data is happening with a view to publish information in acknowledged scientific journals etc.*

Yes

I confirm that TTO has assessed the legal basis prior to the disclosure of data (if not, you must contact TTO at tto@au.dk before you submit this form)*

Yes, TTO has assessed the legal basis for the disclosure of data.

Disclosure of personal data

If you are to disclose personal data in the course of your research project, e.g. due to a change in your place of employment, the data disclosure must be approved and registered by Aarhus University in each individual case.

What you need to do

Skema til videregivelse

Do you have any questions?

NB! The form should NOT be used

Disclosure to third countries (outside the EU/EEA)

Any other permits