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DOH 422-113 August 20 I 7 <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.DaiaR ~q u.est-.@doh.wa .goy. <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 />llltp://ww, .do IL wa. gov/DataandS tal i licalRepor <br />Data user's name and email address: Amyta 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 Was hin gton State Institutional Review Board. <br />Describe in detail how the data will be used and any provisions for re-disclosure. ~e ase incJude the length o f <br />time .you will ne ed 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