Supporting Material 1

Survey of Knowledge, Attitude and Practice Management Patterns of Obstetricians Regarding Stillbirth Pregnancy Outcomes

Affidavit of Nondisclosure

To provide safeguards to privacy and confidentiality in performance of this contract, Battelle staff shall be bound to the following:

1. Battelle staff will ensure that respondent confidentiality is protected. To protect confidential information, Battelle will maintain all records that identify or could potentially identify individuals or establishments under lock and key. All contact data for respondents will be maintained in a separate database from response data. No link between the response data and contact data will be provided to anyone outside of Battelle staff working on the project.

2. Information contained on the survey which would permit identification of any individual or establishment is collected with a guarantee that it will be held in strict confidence by Battelle and will not be disclosed or released to anyone. Battelle staff will not discuss, disseminate or provide access to identifiers for any respondent data to anyone outside of the Battelle staff working on the project.

I hereby certify that I have carefully read and will comply fully with the above procedures on confidentiality.

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(Typed/Printed Name)

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(Signature)

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(Date)