Academic Research License

To obtain further information on a DxCG software license, please complete the requested information. Please provide as much detail as possible. Once DxCG has received your request, we will review it and be in contact with licensing and pricing information. (* = required field)

*Name:	Position/Title:
Organization:	Address:
City:	State:
Country:	Telephone:
Fax:	* Email:

* 1. Product Requested (RiskSmart™ Enterprise, RiskSmart™ Stand-Alone, RiskSmart™ Global Stand-Alone, etc.)

2. Intended uses of DxCG^® software:

3. Funding sources/sponsorship of your project:

4. Data sets to be used (source, payor type, population size):

5. Population type (Commercial, Medicare, Medicaid):

6. DxCG^® models requested (e.g., all-encounter, inpatient, Medicare, Medicaid, RxGroups^®, etc.):

7. Type of Computer: Manufacturer and model of the computer on which the DxCG^® Software is being requested (e.g., IBM-compatible PC, Sun UNIX Workstation).

8. Operating System: Operating system and release number under which the DxCG^® Software is being requested (e.g., Windows NT, Windows 2000, Windows 2003, Solaris 2.6, HP-UX 11.0).

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