Flu AFM Opioids External Data Request Form Date Data Needed e.g. (xx/xx/xx)* (*Note: All data requests require at least 10 business days to process. Due to staff capacity limits, we may not be able to fulfill all COVID-related requests.)Primary First Name* Primary Last Name* Agency* Is this agency a non-profit organization?* No Yes Address 1* Address 2 City StateAKALAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMAMEMDMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZip Phone* Fax Email* Type of Data Requested (please provide a detailed description of data needed)*Purpose/Use of data (briefly describe how data will be used):*Captcha Δ Data & ReportsEpidemiology Data & Reports Communicable Disease Data & Reports Community Health Status Assessment Data Briefs Cook County Data Portal Opioid Reports Population Characteristics Risk Factors Youth Health Status Vital Statistics Updated January 29, 2019, 9:40 AM