< return to TIES website Request an Honest Broker Account Account InformationPersonal InformationName * First Last Job Title * Department/School * Contact Email *Provide an email address where you would like a copy of your application sent to. TIES Study Name *Specify the name of an existing TIES study that you need to be added to. Report Types Accessed *PathologyRadiologyBoth Existing TIES Account? *YesNo TIES Username * Contact InformationWork Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Work Email *Must be either a pitt.edu or upmc.edu email address. Work Phone * Work Fax Next - Supporting Documents 1 / 3 Supporting DocumentsUPMC Honest Broker Application * Honest Broker Approval Letter * Agreements *I agree at the time of this TIES Account Request, and at each and every TIES login, that I:have access to identified pathology reports through coPath or MARS as part of my daily workflow.will use TIES for the purposes of my current research only.will follow all applicable criteria outlined in the UPMC Policy and Procedure Manual. Specifically - Policy: HS-EC1807; Index Title: Ethics and Compliance; Subject: Honest Broker Certification Process Related to the De-identification of Health Information for Research and Other Duties/Requirements of an Honest Broker. Source document located at: http://www.irb.pitt.edu/hipaa/HSEC1807.pdf Next - Submit Application 2 / 3 Submit Your ApplicationreCAPTCHA * This box is for spam protection - please leave it blank 3 / 3
