PRAMS Data Request Form

Today's Date

Date Needed

Requested By

Your Name (required)

Your Organization/Affiliation (required)

Your Email (required)

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Product

Year(s) of data requested

Please describe your project

I understand that the data I receive can only be used for the purpose(s) indicated on the request form. Any other use should be approved by the Maternal and Infant Health Program.

I agree that the data I receive cannot be published without written approval from the Maternal and Infant Health Program.

This Utah Department of Health web site is designed for informational and educational purposes only. The Maternal and Infant Health program does not see patients and is unable to diagnose your illness, provide treatment, prescribe medication, or refer you to specialists. If you need medical treatment, please see your health care provider.