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Section M; SUID and SDY Case Registrk <br />Date of first Advanced Review meeting <br />Date of SUID Case Registry data entry complete <br />Section O: Form Completed B <br />Form completed by — Person's name <br />Form completed by — Title <br />Form completed by — Agency <br />Form completed by — Phone <br />Form completed by — Phone extension <br />Form completed by — Email <br />Form completed by - Date <br />Date of quality assurance completed by State <br />My CDR Outcomes <br />My CDR Outcomes — Person's name <br />My CDR Outcomes - Team of review <br />Source: Code of Federal Regulation Section 164.514(b)(2)(i). <br />IN WITNESS WHEREOF, the parties hereto execute this agreement as follows: <br />Michigan Public Health Institute <br />By: <br />Jana L. Dean, CPA, CIA <br />Chief Financial Officer <br />Michigan Public Health Institute <br />Date: <br />Kittitas County Public Health <br />Data Holder <br />