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AppendixB <br />HIPAA Required Elements to De-Identify Case Data· <br />These data elements will be removed for all persons accessing de-identified case data, per <br />the Data Use Agreement. The source of these data elements is the National Center for <br />Review and Prevention of Child Deaths' Case Reporting System: Case Report Tool. <br />1IIII'tJl/III:0 01l : CIJ,t e Oe/jn/fina. <br />Case number <br />County of review <br />Review team number <br />Sequence of review <br />Death certificate number <br />Birth certificate number <br />Medical examiner/Coroner number <br />Child first name <br />Child middle name <br />Child last name <br />Child name: unknown <br />Date of birth : month , day , and year <br />Date of birth : unknown <br />Date of death: month and day <br />Date of death: unknown <br />Residential address: unknown <br />Residential address: street <br />Residential address: apartment <br />Residential address: city <br />Residential address: county <br />Residential address: zip <br />S !§d iU/I (): /lIddIJIJI/nB)l'lllIIfif)fl <br />Date of incident <br />Date of incident: same <br />Date of incident: unknown <br />Time of incident <br />Time of incident: am or pm <br />Time ofincident: unknown <br />Incident County <br />Death County <br />• It lioll N: Fonll COIIIPleted BI! <br />The names and contact information will be removed . <br />• • Source: hl t p :l/ww~ .hhs .g o v/ocr!c lllnbincdr eg text ,ru!.!~ Section 164.5l4(b)(2)(i) of the rules . <br />9