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If for research has an Institutional Review Board (IRB) review and approval been <br />received? If yes, please provide copy of approval. If No, attach exception. <br />❑ Yes ❑ No <br />III. PERIOD OF PERFORMANCE <br />This Agreement shall be effective from Date of Execution through December 3 F" 2018. <br />IV. DESCRIPTION OF INFORMATION <br />Information Provider will make available the following information under this Agreement <br />upon appropriate payment: (Include the name of the database): <br />® Birth statistical file <br />® Fetal Death statistical file <br />® Linked Birth -Infant Death <br />® Linked Birth -CHARS <br />® CHARS Inpatient <br />® CHARS Observation <br />® CHARS Revisit <br />The information described in this section is: <br />❑ Restricted Confidential Information <br />❑ Confidential Information <br />® Potentially identifiable information <br />Any reference to information in this Agreement shall be the information as described in this <br />Section. <br />V. ACCESS TO INFORMATION <br />METHOD OF ACCESS/TRANSFER <br />® DOH Web Application (CHS Data Files): <br />❑ Washington State Secure File Transfer Service (sft.wa.gov) <br />❑ Encrypted CD/DVD or other storage device <br />❑ Health Information Exchange (HIE)* * <br />❑ Other: (describe the methods for access/transfer)** <br />**Note: DOH IT Security Officer must approve prior to Agreement execution. IT Security <br />Officer will send approval/denial directly to DOH Contracts Office and DOH Business <br />Contact. <br />FREQUENCY OF ACCESS/TRANSFER <br />❑ One time: DOH shall deliver information by (.date) <br />❑ Repetitive: frequency or dates <br />® As available within the period of performance stated in Section III.D. <br />OTHER PROVISIONS <br />Page 4of16 <br />rev 07/02/2013 <br />