TDDRequest-A2408-003

Member Proposal Form

Project Name

GLP-1

Cohort Requirements

Age: 18+
Gender: All genders
Diagnosis: All diagnoses
Treatment: Prescribed a GLP-1 receptor agonist
Observation Period: 12 months prior to initiation of GLP-1 treatment through 1/1/2025

Data Collection Specifications

Anonymized data set containing in CSV, excel or SQL formats.

Data fields per item required:

Patient Table: Includes all patients satisfying the cohort requirements.
Condition Table: Includes all diagnoses associated with cohort members during the observation period
Procedure Table: Includes all procedures associated with cohort members during the observation period
Treatment Table: Includes all medications (semaglutide and all other drugs) associated with cohort members during the observation period
Measurement Table: Includes all laboratory tests associated with cohort members during the observation period

Full Name

Company Name

Phone Number

Email Address

Patients

SetupFee

PricePerPatient

DeliveryTime

Comments

Questions