Virginia All-Payer Claims Database (APCD) Request Form

Are you an employee of the Virginia Department of Health (VDH), Virginia Department of Medical Assistance Services (DMAS) or the Bureau of Insurance (BOI)?*

YesNo

Please indicate whether you would like access to the MedInsight platform:*

YesNo
Click here to download the APCD New User Form.

Please fill in the required information and submit your completed form to the provided point of contact below.
Meredith Olson

Data Training Coordinator

meredith.olson@vdh.virginia.gov
If you are interested in receiving a dataset or custom report, please email APCDsupport@vhi.org.
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Virginia All-Payer Claims Database (APCD)

Data Request Form
By completing this form, I confirm that I am authorized to act on behalf of my team and acknowledge the following responsibilities:

Review and Approval
I understand that this request will be reviewed by the Virginia APCD Data Release Committee to ensure alignment with legislative intent and compliance with Virginia Code section § 32.1-276.7:1.

Data Subscriber Agreement
If approved, I understand that a Data Subscriber Agreement must be fully executed before any data is released.

Publication and Dissemination Review
I understand that all publications, presentations, or other public disclosures resulting from Virginia APCD data must be submitted to Virginia Health Information (APCDSupport@vhi.org) and any named entities referenced in the work for a 30-day review period prior to release.

Data Destruction
I understand that my team must destroy all Virginia APCD data upon completion of the approved research, unless explicit permission is obtained from VHI to retain it for future use.

Use Limited to Approved Scope
I understand that Virginia APCD data may only be used for the specific project outlined in this request and approved by the Data Release Committee. I understand that any additional use will require a new request form submission and approval.

Linkage and Re-Identification
I acknowledge that intended linkage to any outside data sources must be included in this request form and approved by the Data Release Committee. I understand that re-identification of individuals or entities within the Virginia APCD is strictly prohibited and would constitute a violation of the law.

Data Applicant Information
Name*

First NameLast Name
Email*
example@example.com
Organization Name*
Organization Type*

ResearcherGovernment AgencyHealthcare ProviderNonprofit OrganizationOther
Have you worked with claims data in the past?:*

NoYes
What datasets have you used previously?:
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Data Security
Please provide the name of the organization that will host and manage the data (if different than the requestor).
How and where will the data be located physically?*
Server Type*

CloudLocalOther
Provide the name, title, and organization of all individuals that will be allowed to have access to the data.
Has your organization experienced a data breach in the past?*

YesNoNot Sure
Please describe the incident.*
What policies, if any, were implemented in response to the incident described?*
What policies and procedures are in place to ensure the data will be protected while stored on server(s)? (e.g., data encryption, user authentication process, locked offices)*
Does your organization have an information security certificate (e.g., SOC 2, HITRUST)?*

YesNoNot sure
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Data Destruction
How long will you need access to the data for?*

One yearTwo yearsThree yearsOther
If you have any questions while completing this form, please email APCDsupport@vhi.org.

Additional Information Required
In order to complete your application, please fill out the Data Dictionary form to the best of your ability and upload below.
Data Dictionary*

Browse Files

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Please upload any supplemental files (e.g., abstract, IRB approval letter, security plan) below.
Supplemental files

Browse Files

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If you have any questions while completing this form, please email APCDsupport@vhi.org.
Should be Empty:

Virginia All-Payer Claims Database (APCD)

Data Applicant Information

Project Information

Data Security

Data Destruction

Additional Information Required