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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 />INFORMATION RECIPIENT <br />Organization Name Kittitas County Health <br />Business Contact Name Tristen Lamb <br />Title Interim Public Health <br />Administrator <br />Address 507 Nanum St. Suite 107, <br />Ellensburg, WA 98926 <br />Telephone# 509-962-7003 <br />Email Address amy.fuller@co.kittitas.wa.us <br />Data User Contact Name Amy Fuller <br />Title Assessment Coordinator <br />Address 507 Nanum St. Suite 107, <br />Ellensburg, WA 98926 <br />Telephone# 509-962-7002 <br />Email Address a my. fuller@co. kittitas. wa. us <br />IT Security Contact Jim Goeben <br />Name <br />Title 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 />Privacy Contact Name Candi Blackford <br />INFORMATION PROVIDER <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 />katie .hutchinson@doh .wa .gov <br />Todd Rime/ Victoria Lazariu <br />Data Steward <br />P.O. Box 47814 <br />Olympia, WA 98504-7814 <br />360 -236-4310 <br />CHS .DataReguests@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 />trac~.au ldredge@doh.wa .gov <br />Aaron Bryant <br />Page 1 of 26 <br />09/2017