Requestor Contact Information
* First Name:
* Last Name:
* Organization Type:
Other (please specify):
* Organization Name:
* Zip Code:
* Email Address:
* What is/are your project/research question(s)?
* How will these data be used?
NOTE: Before describing the requested data, please keep in mind that multidimensional tables may result in small numbers. To keep individual's information confidential, any data cells with less than 5 cases will simply be denoted as '<5'. Cross tabulations cannot be provided where (1) stratum-specific population denominators are <100, (2) the totals would allow for the calculation of the number and/or (3) a cell contributes to the majority of events. Further, hospital, physician or site-specific aggregate statistics will not be released.
* Please describe the data you are interested in. Additionally you may also make your selection(s) below (see 1. and 2.). Unless otherwise specified, the time period for data requests is based on the period during which cases were reported.
1. Disease measurement by year(s), time period(s), and geographic area(s) (select all that apply)
2. Demographic and risk factors (select all that apply)
Data Delivery Method
* Desired Completion Date:
Desired delivery format (optional) Unless otherwise specified, you will receive the data as an email attachment in PDF format.
Email with attachment in another format (please specify):
Other (Please specify):
By submitting this data request I agree to the following provisions:
Protecting the confidentiality of HIV/AIDS surveillance information is the foremost concern of the Division of HIV and STD Programs (DHSP).
The release of surveillance data containing individually identifying information is strictly prohibited. The terms and conditions for the release of data must be consistent with applicable laws.
DHSP reserves the right to suppress data to maintain case confidentiality.
All publications using the data provided must acknowledge DHSP. The following is a suggested citation:
Los Angeles Department of Public Health,
Division of HIV and STD Programs .
The dissemination of any interpretations or findings based upon the data provided must be accompanied by the following disclaimer:
The authorized release of HIV/AIDS summary data by the Los Angeles Department of Public Health, Division of HIV and STD Programs, should not be construed as an endorsement of any analyses, interpretations, or conclusions reached by the author(s).
The data provided will be used only for the purposes stated in the data request form.
The time period for data requests is based on the period during which cases were reported,
unless otherwise specified. Please submit your request only if data is not available at AIDSVu.org,
the LA County online health data query system,
or in our Annual HIV Surveillance Reports at http://publichealth.lacounty.gov/dhsp/Reports.htm/.