Individual Payment Data Request

Please use this form to request access to an individual’s Sunshine Payment Data collected by Siemens.

 

I am requesting access to my potentially reportable data. I certify that: (a) all of the information I am entering on this Request Form is accurate, and (b) the data requested pertains to me, or else the person to whom the data pertains has authorized me to request such access and see the data on his or her behalf. I understand that Siemens is expressly relying on my certification.



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An issue occurred on this form. Either, one or more missing and/or incorrect entries are in the form. Each is underlined in red. Or, the data inserted by you seems to be invalid. Please check if you filled in all form fields as expected according to the field names (e.g. ‘First Name’, ‘Last Name’ etc.). Please correct and re-submit your request again. Thank you!

An issue occurred on this form. The data inserted by you seems to be invalid. Please check if you filled in all form fields as expected according to the field names (e.g. ‘First Name’, ‘Last Name’ etc.). Please correct and re-submit your request again. Thank you!

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Thank you for your submission.  We are now processing your request.

Due to technical reasons your request cannot be completed. Please try again or contact us. We apologize for the inconvenience caused.

If you have any questions, please contact transparency.healthcare@siemens.com.