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Today's Date <br />07/14/2017 <br />Fund/Department <br />116 -Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />Contract /Grant Agency: Child Death Review Case Reporting Data Use Agreement Addendum <br />Period Begin Date: May 1, 2017 Period End Date: December 31, 2020 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Child Death Review Case Reporting System Data Use Agreement between the Michigan Public <br />Health Institute and the Kittitas County Public Health Department establishes the terms and conditions <br />for the collection, storage, and use of data obtained from the case reviews of child deaths. The <br />Addendum amends the introductory paragraphs of Appendix B to explicitly list all 18 HIPPA identifiers. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office <br />Signature of Auditor's Office <br />Date <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ <br />Percentage County Funds <br />State Funds $ Federal Funds $ <br />Matching Funds $ CFDA# <br />Grant/Contract Review Page 1 <br />