Download Confidentiality Data Sharing Agreement for Free

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This Agreement is made by and between xxx and the Public Health Branch of the
0000(PHB). This Agreement is effective from the date the last of the authorized
representative of the parties hereto, listed on the last page of the Agreement, has executed
the Agreement.
PHB representative have met with xxx representatives to develop plans for PHB to
analyze population data from the diabetes registry (PECYS) maintained by the xxx and
populated with diabetic patient data submitted by Humboldt County medical providers.
PHB seeks to receive current and historical data from PECYS for analysis of community
trends of diabetes and related conditions reported to PECYS, such as smoking, blood
pressure and level of diabetic and cholesterol control, including geocoding and mapping
of the data by census tract in Eureka and Arcata and zip code in other areas of the county.
The purpose of such mapping would be to identify potential health disparities and
facilitate interventions to improve health outcomes.
IPA now seeks to send this data to PHB and to receive analysis results from the PHB
team so as to better perform its own efforts to improve health outcomes.
NOW THEREFORE, the parties agree as follows:
1. Transfer of Data to PHB. PHB will work with personnel of xxx to establish the
transfer of current and historical PECYS data, absent the names of patients
2. Use/Disclosure of data. PHB shall use the data solely for the purposes stated in
the recitals above.
3. Disclosure of PECYS Data. PHB shall make ProcessData available to the xxx
and others as mutually agreed upon by the xxx and PHB. The ProcessData will
include the following type of aggregate and de-identified data:
GIS mapping of location of diabetic patient with sufficient grouping to
protect identification of individual, i.e. aggregation to the census tract and
zip code level as defined above.
GIS mapping of pertinent data points contained in PECYS to elucidate
diabetes related health habits, degree of optimum control of diabetes and
related health conditions and adequacy of medical services provided.
4. Data protocols and procedures. In general the following protocols and procedures
shall be established.
Confidentiality Data Sharing Agreement
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