Renewal and revision of this agreement. The terms of this agreement may be revised at any time, pending review and agreement by both CDC and NCFRP. At a minimum, the terms will be reviewed and updated, as necessary, at the start of each CDC funding cycle. By the authority vested in me as a representative of the CDC’s SUID & SDY Case Registry team, my signature indicates the CDC’s SUID & SDY Case Registry team agreement to comply with these requirements. Name: Xxxxxx Xxxxx Xxxxx, PhD, MPH By the authority vested in me as a representative of MPHI/ NCFRP my signature indicates agreement to comply with these requirements. Xxxxxx Xxxx Name: Title: Senior Epidemiologist Title: Finance & Budget Manager Michigan Public Health Institute Organization: SUID & SDY Case Registries Centers for Disease Control and Prevention Signature: Organization: Signature: 10/29/2018 Date: Date: 10/22/18 Appendix A HIPAA Required Elements to De-Identify Case Data* The NFR-CRS supports two types of data downloads: identified and de-identified. NCFRP staff and researchers who have been approved by the NCFRP will receive only de-identified data. The NFR-CRS variables that will be removed in de-identified downloads are listed below. The NFR-CRS contains many free text fields (most often in the ‘specify’ or ‘describe’ text fields). The NFR-CRS also provides users the opportunity to provide more detail surrounding the circumstances of the death in Section O: Narrative text field. When the Narrative, ‘specify,’ and/or ‘describe’ text fields are included in a de-identified download, the Narrative, ‘describe,’ and ‘specify’ text fields SHOULD NOT contain any HIPAA Identifiers. HIPAA Identifiers include names; all geographical subdivisions smaller than a state; all elements of dates (except year) for dates directly related to an individual; phone numbers; fax numbers; electronic mail addresses; social security numbers; medical record numbers; health plan beneficiary numbers; account numbers; certificate/license numbers; vehicle identifiers and serial numbers; device identifiers and serial numbers; web universal resource locators; internet protocol address numbers; biometric identifiers; full face photographic images; and any other unique identifying number, characteristic or code. Identifying information can be entered into the NFR-CRS element fields in the list below, including free text fields associated with the listed fields, because all the listed fields and their related text fields will be removed from every de-identified dow...
