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ODM Certification

ODM Certification

Name of Organization

Contact Name

Phone Number

Email

Website

Customer Type

New customer

Re-certification for new ODM version or new product

Other…

Enter other…

Size of Organization

Small (1-99 employees)

Medium (100-999 employees)

Large (>= 1000 employees)

Use Cases to Certify

Metadata Export

Metadata Import

Metadata Interoperability ¹

Snapshot Clinical Data Export ²

Transactional Clinical Data Export ²

Snapshot Clinical Data Import ³

Transactional Clinical Data Import ³

¹ Metadata import and export are pre-requisites
² Metadata export is a pre-requisite
³ Metadata import is a pre-requisite

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Comments

Leave this field blank

Clear Data. Clear Impact.

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