OPTIMA Data Modification Request

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OPTIMA Data Modification Form

Please complete the below request if you need to change any Stratification Data entered incorrectly at the time of Randomisation, OR if you need to delete a form / information entered in error.

Name of person making request

TNO

Site Name

Form Name (i.e Participant / Annual Follow up Form / Chemotherapy Form)

Type of request

IMPORTANT

If this is a Patient Transfer request, please select Patient Transfer from the "Data item" drop down. You should confirm the current Site in "incorrect data" and the new Site in "CORRECT data".

If this is a Data Deletion request, please select other from the "Data item" drop down and confirm what needs deleting in the free text box.

Please provide specific DMR information below:

Data Item

Other please confirm:

Incorrect data entered

CORRECT data to be entered

Reason for change request

Type of error

Privacy notice

The information you provide may be shared with the OPTIMA Trial Management Group but will not be shared more widely. The above information will be sent to OPTIMA@warwick.ac.uk to allow us to process the Data Modification Request.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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