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Medical Office Survey on Patient Safety Culture DUA Submission Portal

Data Use Agreement

Each medical office wishing to participate in the Medical Office Survey on Patient Safety Culture Comparative Database is required to sign a Data Use Agreement (DUA) each submission period. The DUA assures the confidentiality of the data and explains how the data will be used. The completed and signed DUA can be submitted at any time. The DUA can be uploaded directly to the submission system through the DUA submission portal, emailed to DatabasesOnSafetyCulture@westat.com, or faxed to 1-888-852-8277.

Medical Office Data Use Agreement (PDF, 188 KB, PDF HELP)

For technical assistance, please email DatabasesOnSafetyCulture@westat.com or call 1-888-324-9790.