Patient Generator Test Data Request Form

MiHIN Patient Generator Test Data Request Form

Please use this application form to request realistic test data from the MiHIN Patient Generator. Once the form is submitted, the MiHIN team will review and contact you regarding any questions for the data sets you have specified.

Requesting Party Information:
  • Please enter your phone number in the format (###)###-####.
  • Please describe the purpose for your data request to ensure we understand the type of data you need.

    NOTE: Pricing is determined based on nature of request.
  • In this section please specify the types of data you would like to generate using Patient Generator and the number of unique records you wish to generate by type.
  • Use this field if you selected 'Other' above.
  • Please list the number of records you are requesting for any of the requested data.