Child Death Review Case Reporting Data Use Agreement Addendum

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Identifying information can be entered into the CDR -CRS element fields in the list below, including free text fields associated with the listed fields, because all the listed fields and their related text fields will be removed from every de -identified download. However, Users should be instructed by the Holder not to enter any identifying information in other free text fields, including Section N: Narrative text field, because these text fields may be included in de -identified downloads. NCFRP cannot review free text fields in de -identified downloads to assure that they contain no HIPAA Identifiers. HIPAA Required Elements to Dc-Identifv Case Data The CDR -CRS elements listed below will be removed for all persons accessing de -identified case data: Inlroduct.ion: Case Definition Case number County of review Review team number Sequence of review Death certificate number Birth certificate number Medical examiner/Coroner number Date CDR team notified of death Sectiun A: Child In ormation Child first name Child middle name Child last name Child name: unknown Date of birth: month, day, and year Date of birth: unknown Date of death: month and day Date of death: unknown Residential address: unknown Residential address: street Residential address: apartment Residential address: city Residential address: county Residential address: zip Section D: Incident Information Date of incident Date of incident: same Date of incident: unknown Time of incident Time of incident: am or pm Time of incident: unknown Incident county Death county Section L: Review Meeting Process Date of first CDR meeting 2