Limited Data Request Instructions
Hospitals and Local Health Departments
Log in to the Data Request Portal and complete the Limited Data Request form.
- If your hospital or local health department is using an outside contractor(s), you will need to attach a current Business Associate Agreement, signed within the last three years, between the hospital or health department and each contractor.
- If your hospital is an Affiliated Covered Entity (ACE) you will need to attach the organizational chart for your facility
An analyst will review the completed request and contact you through the request portal if any corrections or clarifications are needed.
Once the request passes the analyst’s initial review, it will be sent back to you to be signed along with the Data Use Agreement(s) (DUA). You will need to print out both the request form and DUA.
- No changes may be made to the request form or DUA before returning them for signatures. A request without a signed DUA or a DUA that is signed but has been altered will not be approved.
- Hospitals: The CEO, or equivalent, needs to sign the data request form and DUA.
- Local Health Departments: The Health Officer must sign the data request form and DUA. A DUA must be signed for each person that will have access to the data.
- The Delegation Order OSH-ISD-520 may be signed by the Hospital CEO, Health Officer, or equivalent to allow the designated delegate to sign the form on behalf of the Local Health Department.
The signed request form and DUA should be scanned and uploaded to the online portal as a PDF.
OSHPD management will review the signed documents and request package.
Once cleared for data release by management, OSHPD will contact the listed contact person on the request form to arrange data delivery. Data will be sent as Encrypted Files delivered via secure file transfer protocol. You can find instructions here.