Develop Heart Failure Registry database

Hello, How are you today? Please I will like you to design an Heart Failure registry where doctors can log in to enter information about their patients showing from heart problems. There are various sets of information that will be entered. I have the form that they will fill in (it is about 6 MS Word pages) which contain different information probably about 100 or more input areas. There will be the main admin (probably 2 or more main admins) who can create user accounts for the doctors. The doctors can only view the information of the patients they entered whereas the main admin can view all the information of all the patients entered by the various doctors (users). The main admin and the users should be able to see the information of those they entered and even where possible a statistic representation of the entered information. They should be able to export the entered information for the patients into SPSS and Access. If the user forgot his password, he should be able to retrive it by filling his email. The database will be 100% online. As well as the filling of the form. I will give you the form to be entered before I accept your bid. I can add it here for security of the form. How do you secure the database and I need it to be having a daily or twice daily back up say in 1 or 2 locations like dropbox. So what is your least for this project and I need it completed within 4 days. Chinedu