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Today's Date <br />04/05/2017 <br />Fund/Department <br />116 -Public Health <br />s\ <br />Kittitas County f' <br />Review Form �-- <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />Contract /Grant Agency: Data Use Agreement for Limited Data Set between KCPHD and KVH <br />Period Begin Date: 04/17/2017 Period End Date: 04/17/2022 <br />Total Grant/Contract Amount: $None <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The purpose of the Data Use Agreement for Limited Data Set between KCPHD and KVH is to provide <br />recipient with access to a limited data set for special department projects in accord with the HIPAA <br />Regulations. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: <br />Administrator Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office Date <br />Signature of Auditor's Office <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Grant/Contract Review Page 1 <br />