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Section M: SUIDand SDY Case RegisLry <br />Date of first Advanced Review meeting <br />Date of sum Case Registry data entry complete <br />Section 0 : Form Completed Bv <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 />Michl_ <br />By:----.:~="""'~~~~~~------ <br />;Jafift L. Hem J" t:( I'l l C. c: t<. ,',{ t{ I (: t' I (Yl {; A <br />ehief Financittl Officer F,' t'I (0'1 C( I-8""",) -l.f Me? VI. A or-'" <br />Michigan Public Health Institute <br />Date: 'b J ((., (() f ( <br />Kittitas County Public Health Dam H;O-&t8 <br />By. .7Z\) <br />Dat <br />3