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'PlHealth <br />DOH 422-113 August 2017 <br />Data Sharing Agreement Information Sheet <br />Center for Health Statistics <br />P.O. Box 9709 <br />Olympia, WA 98504-9709 <br />360-236-4310 <br />A Data Sharing Agreement (DSA) with the WA State Department of Health is required to receive Comprehensive <br />Hospital Abstract Reporting System (CHARS), Birth, Fetal Death, Linked Birth -CHARS, and Linked Birth -Infant <br />Death data files. To start the data sharing process, fill out this information sheet, then email to <br />CHS.DataRequestsfr}doh_�ua.t <br />NOTE. Information on this sheet will be directly copied into the Data Sharing Agreement. <br />For descriptions of the available data sets, see: <br />http;l/www.doh, wa_gov/Dataand5tatisticalReportsl V itaIStatis6csData/OrderDataFiles.asgx <br />Data user's name and email address: Amvta Fuller <amy.fuller@co.kittitas.wa.us> <br />Check the data set(s) you are requesting: <br />® CHARS ® Birth ® Fetal Death ® Linked Birth -CHARS ® Linked Birth -Infant Death <br />This agreement is to receive limited unidentified data. If your purpose is to re -identify or contact individuals or link <br />to other data you will need approval from the Washington State Institutional Review Board. <br />Describe in detail how the data will be used and any provisions for re -disclosure. Please include the length of <br />time you will need the data: <br />Data will be used to inform community health assessment reports, which occur on a 3 to five year <br />cycle. No confidential information will be shared; the only data that will be utilized is general <br />population measures, sorted by demographic category. There may also be intermittent access to <br />general hospitalization rate data, or death/birth data to inform grant applications as well. <br />DOH 422-113 August 2017 <br />