Impac Software: The Elekta Group

Voluntary Call for Data from Cancer Registry Customers
Impac Software registry customers regularly contribute data to Impac Software’s National Oncology DataBase™ (NODB) through quality-checked submissions directly from their registry software. In return, Impac Software provides primary site-specific aggregate data reports to contributors via the Internet. Impac Software’s registry customers can use this information to generate annual reports, internal comparative reviews, and much more.

If you are interested in learning more or signing up for the program, please complete the form below. You can also review frequently asked questions by clicking here.

NODB Voluntary Call for Data Information Request Form

Note! To ensure that your request is correctly processed, please complete all fields prior to pressing the Enter key on your keyboard or clicking on the Submit button appearing at the bottom of the form. * = required field.

Institution Information
Institution:	*
ACoS FIN Number:	*
Address 1:	*
Address 2:
City:	*
State/Province:	*
Postal Code:	*
Country:	*
Contact Information
Full Name:	*
Title:	*
Department:	*
Phone:	*
Fax:
Email:	*
Software Information
Current Registry Software:	*
If Other, Specify:
Version:	*

Please review the following terms and conditions.
NODB Voluntary Call for Data Terms & Conditions By checking the "I Accept" box below, you agree that Impac Software may aggregate treatment and related data, including Protected Health Information ("PHI") (as defined by the Health Insurance Portability and Accountability Act ["HIPAA"] regulations), provided by you with the data, including Protected Health Information, of other Covered Entities to provide you with quality assurance data analyses relating to your Health Care Operations. Under no circumstances may Impac Software disclose the Protected Health Information of one Covered Entity to another Covered Entity absent the explicit written authorization of the Covered Entity. Impac Software employs and maintains appropriate safeguards to prevent unauthorized use or disclosure of individually identifiable health information.
I accept. I do not accept. *

Note! A request acknowledgement will be automatically displayed after you click the Submit button. The information you submitted and the follow-up instructions will appear on this page. Please print a copy of the acknowledgement page for your records.

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