
Screen4Success Help Center
Welcome to the Screen4Success (S4S) Help Center. Here you will find resources and tools to help you get started with S4S. This page will be continuously updated with new information, so check back for our latest resources.
Contents
This page contains the following topics:
Consent/Assent Form
Every Participant is asked to complete a consent/assent form which will allow or not allow their de-identified (no nickname, email address, ID) screener data to be used by researchers for secondary analysis.
Review a sample Consent/Assent Form here
Sample Participant Consent Form
Sample Consent For Minor Form
Data Use Agreements (for Professional Accounts only)
The Data Use Agreement (DUA):
- Is a legal form that must be signed by an authorized individual at your agency/organization when your agency wishes their employees to use Screen4Success with individuals they serve.
- Explains that data will be hosted on servers under the control of Chestnut Health Systems, Inc. (the national coordinating center for Screen4Success).
- Explains that Chestnut Health Systems, Inc. must comply with the requirements of 42 C.F.R. Part 2, the HITECH Act, and the Privacy and Security Rules.
- Offers agencies/organizations the ability to contribute to an aggregated, de-identified Limited Dataset that will be analyzed by researchers to understand health, wellness and well-being, and assess health disparities, at the population level to inform policy and funding opportunities.
Important: You can send the DUA to be reviewed by the appropriate persons at your agency.
Review a sample DUA here:
Screen4Success Data Use Agreement - Covered Entity
Screen4Success Data Use Agreement - Non-Covered Entity
Score Calculation Sheet
This spreadsheet shows and explains all the scores we calculate.