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Appendix B <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 />Introduction : Case Definition <br />Case number <br />County of review <br />Review team number <br />Sequence of review <br />Death certificate nu~ber <br />Birth certificate number <br />Medical examiner/Coroner number <br />Seclion 11 : Child Jn for mati()It <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 />Section D .' In cident Information <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 of incident: unknown <br />Incident County <br />Death County <br />Sectioll N : Ferm Completed BII <br />The names and contact information will be removed . <br />• • Source: h ttp://www.hhs .g"Qv/ocr/combincdregre)ltpdi~ Section l64.514(b )(2)(i) of the rules. <br />1