données informatisées et validées en transplantation computer engineer: p. daguin scientific council coordinator: pr m. giral
Données Informatisées
et VAlidées en Transplantation
Computer engineer: P. Daguin
Scientific council coordinator: Pr M. Giral, CHU Nantes
Scientific council:
Pr M. Kessler, Dr M. Ladrière, CHU Nancy
Pr C. Legendre, Pr H. Kreis, CHU Necker Paris
Pr D. Glotz, Dr C. Lefaucheur, CHU Saint-Louis Paris
Pr L. Rostaing, Pr N. Kamar, CHU Toulouse
Pr J.P. Soulillou, CHU Nantes
Pr G. Mourad, Dr V. Garrigue, CHU Montpellier
Pr E. Morelon, Dr F. Buron, CHU Lyon
Pr E.Cassuto, Dr L. Albano, CHU Nice
Project of
collaborative study
with the DIVAT network
Émetteur : itun
Coordination DIVAT
Version : 3
Date : 20/12/2013
P : 1/2
Title of the study:
Surname(s), first name(s) and function of the investigator(s):
Summary of the project (in about 20 lines):
Type of project:
Thesis
Report
Written or oral communication
Name and signature of the person in charge of the request:
Date:
I wish to collaborate with the following center(s):
Nantes ITUN - Hotel Dieu Hospital
Toulouse - Rangueil Hospital
Nancy - Brabois Hospital
Montpellier - Lapeyronie Hospital
Paris - Necker Hospital
Lyon - Edouard Herriot Hospital
Centers participating have to return their authorization signed to the
submitting researcher and a copy to the secretarial office of DIVAT in
Nantes.
Nancy
BRABOIS
Nantes
ITUN
Paris
NECKER
Toulouse
RANGUEIL
Montpellier
LAPEYRONIE
Lyon
HERRIOT
Nancy
BRABOIS
I agree to participate in the study proposed by Nancy and I give
permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nancy and I give
permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nancy and I give
permission to use data from Toulouse within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nancy and I give
permission to use data from Montpellier within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nancy and I give
permission to use data from Lyon within the DIVAT network.
Signature:
Nantes
ITUN
I agree to participate in the study proposed by Nantes and I give
permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nantes and I give
permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nantes and I give
permission to use data from Toulouse within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nantes and I give
permission to use data from Montpellier within the DIVAT network.
Signature:
I agree to participate in the study proposed by Nantes and I give
permission to use data from Lyon within the DIVAT network.
Signature:
Paris
NECKER
I agree to participate in the study proposed by Necker and I give
permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by Necker and I give
permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by Necker and I give
permission to use data from Toulouse within the DIVAT network.
Signature:
I agree to participate in the study proposed by Necker and I give
permission to use data from Montpellier within the DIVAT network.
Signature:
I agree to participate in the study proposed by Necker and I give
permission to use data from Lyon within the DIVAT network.
Signature:
Toulouse
RANGUEIL
I agree to participate in the study proposed by Toulouse and I give
permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by Toulouse and I give
permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by Toulouse and I give
permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by Toulouse and I give
permission to use data from Montpellier within the DIVAT network.
Signature:
I agree to participate in the study proposed by Toulouse and I give
permission to use data from Lyon within the DIVAT network.
Signature:
Montpellier
LAPEYRONIE
I agree to participate in the study proposed by Montpellier and I give
permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by Montpellier and I give
permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by Montpellier and I give
permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by Montpellier and I give
permission to use data from Toulouse within the DIVAT network.
Signature:
I agree to participate in the study proposed by Montpellier and I give
permission to use data from Lyon within the DIVAT network.
Signature:
Lyon
HERRIOT
I agree to participate in the study proposed by Lyon and I give
permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by Lyon and I give
permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by Lyon and I give
permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by Lyon and I give
permission to use data from Toulouse within the DIVAT network.
Signature:
I agree to participate in the study proposed by Lyon and I give
permission to use data from Montpellier within the DIVAT network.
Signature:
Centre extérieur à DIVAT
I agree to participate in the study proposed by the researcher and I
give permission to use data from Nancy within the DIVAT network.
Signature:
I agree to participate in the study proposed by the researcher and I
give permission to use data from Nantes within the DIVAT network.
Signature:
I agree to participate in the study proposed by the researcher and I
give permission to use data from Necker within the DIVAT network.
Signature:
I agree to participate in the study proposed by the researcher and I
give permission to use data from Toulouse in the DIVAT network.
Signature:
I agree to participate in the study proposed by the researcher and I
give permission to use data from Montpellier within the DIVAT network.
Signature:
I agree to participate in the study proposed by the researcher and I
give permission to use data from Lyon within the DIVAT network.
Signature:
C.H.U. HOTEL-DIEU-30 Bd Jean Monnet – 44093 NANTES CEDEX 1 (France)
Tél (ligne directe) + 33 (0) 2 40 08 74 49 . (Secrétaires) + 33 (0) 2
40 08 74 54 . Fax + 33 (0) 2 40 08 74 48.
Email : [email protected] ou [email protected]







