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DATA SHARING AGREEMENT <br />FOR <br />CONFIDENTIAL INFORMATION OR LIMITED DATASET(S) <br />BETWEEN <br />STATE OF WASHINGTON <br />DEPARTMENT OF HEALTH <br />AND <br />KITTITAS COUNTY HEALTH <br />This Agreement documents the conditions under which the Washington State Department of <br />Health shares confidential information or limited Dataset(s) with other entities. <br />CONTACT INFORMATION FOR ENTITIES RECEIVING AND PROVIDING INFORMATION <br />Organization Name <br />Business Contact Name <br />Title <br />Address <br />Telephone # <br />Email Address <br />Data User Contact Name <br />Title <br />Address <br />Telephone # <br />Email Address <br />IT Security Contact <br />Name <br />Title <br />INFORMATION RECIPIENT I INFORMATION PROVIDER <br />Kittitas County Health <br />Tristen Lamb <br />Interim Public Health <br />Administrator <br />507 Nanum St. Suite 107, <br />Ellensburg, WA 98926 <br />509-962-7003 <br />amy.fuller@co.kittitas.wa.us <br />Amy Fuller <br />Assessment Coordinator <br />507 Nanum St. Suite 107, <br />Ellensburg, WA 98926 <br />509-962-7002 <br />amy.fuller@co.kittitas.wa.us <br />Jim Goeben <br />IT Director <br />Address 205 W 5th Ave, Ellensburg, WA <br />98926 <br />Telephone # 509-312-0213 <br />Email Address jim.goeben@co.kittitas.wa.us <br />Washington State Department of <br />Health (DOH) <br />Katie Hutchinson <br />Senior Epidemiologist <br />P.O. Box 47814 <br />Olympia, WA 98504-7814 <br />360-236-4324 <br />Todd Rime /Victoria Laza riu <br />Data Steward <br />P.O. Box 47814 <br />Olympia, WA 98504-7814 <br />360-236-4310 <br />CHS. Data Requests@doh.wa.gov <br />Tracy Auldredge <br />DOH Chief Information Security <br />Officer <br />PO Box 47890 <br />Olympia, WA 98504-7890 <br />360-236-4432 <br />tracv.a uId redjze C@ d oh.wa.eov <br />Privacy Contact Name I Candi Blackford I Aaron Bryant I <br />Page 1 of 26 <br />09/2017 <br />