HomeMy WebLinkAboutCONSENT PH Data sharing with State 615 Sheridan Street
Port Townsend, WA 98368
�e etson www.JeffersonCountyPublicHealth.org
Public He� Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, County Administrator
FROM: Apple Martine, Jefferson County Public Health Director
Alyssa Wyrsch, Epidemiologist
DATE: F;,�,byya"j �, 2,02
SUBJECT: Agenda item — Data Sharing Agreement with DOH for confidential information
or limited dataset(s) related to Jefferson County Healthy Youth Survey
STATEMENT OF ISSUE:
Jefferson County Public Health Administrative Division requests Board approval of Jefferson County Data
Sharing Agreement between WA Department of Health (DOH) Healthy Youth Survey — March 15, 2025 -
March 15, 2029
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
The purpose of this agreement is to allow WA State DOH to share access to Healthy Youth Survey data. The
Healthy Youth Survey (HYS) is a multi-agency collaborative research study conducted under the authority of
RCW 69.50.540 (1)(b)(i)(B). DOH and partner agencies are obligated to collect, analyze, and report on survey
results at least every two years. The HYS collects information from 6th-12th graders in Washington on a
range of health indicators that can inform programs and policies related to adolescent health. HYS data will
be used to support ongoing surveillance and policy and program evaluation efforts related to adolescent
wellbeing. Policy development may also be informed using these data.
The HYS has been approved by the Washington State Institutional Review Board (WSIRB). The WSIRB
authorizes DOH to release a full dataset to state, Tribal, and local public health partners using the data to
support surveillance and evaluation without further WSIRB review.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
There is no charge for this service. There is no fiscal impact.
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
AD-25-003
RECOMMENDATION:
Jefferson County Public Health administrative division requests Board approval of Jefferson County Data
Sharing Agreement between WA Department of Health (DOH) Healthy Youth Survey — March 15, 2025 -
March 15, 2029
REVIEWED BY:
�z I !?�i r 1,09i Z.,.7s-
Mark McCauley, Count� dministrator Date
.Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
Always working for a safer and healthier community
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: WA Dept of Health Contract No: AD-25-003
Contract For: Data Share: Healthy Youth Survey Term: 3/15/2025 - 3/15/2029
COUNTY DEPARTMENT: Public Health
Contact Person: Apple Martine
Contact Phone: x443
Contact email: amartine@co.jefferson.wa.us
AMOUNT: o PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
SOUrces(S) of Matching Funds Vendor List Bid
Fund # RFP or RFQ
Munis Org/Obj Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WIT-14C. f3,5,�5.080 AND CHAPTER 42.23 RCW.
0 CERTIFIED: N/A: ■ / Jan. 21, 2025
F
Stgnatuie. F Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT B EN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY. 'R �
CERTIFIED: � N/A: ,,.f�. �� Jan. 21, 2025
Signatute':' Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 1/28/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 1/24/2025.
State contract -- cannot change.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
DOH Contract # CLH27388
IT DATA SHARING AGREEMENT
FOR
CONFIDENTIAL INFORMATION OR LIMITED DATASET(S)
BETWEEN
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
AND
Jefferson County Public Health
This Agreement documents the conditions under which the Washington State Department of
Health shares confidential information or limited Dataset(s) with other entities.
CONTACT INFORMATION FOR ENTITIES RECEIVING AND PROVIDING INFORMATION
INFORMATION RECIPIENT INFORMATION PROVIDER
Organization Name Jefferson County Public Health Washington State Department of
Health (DOH)
Business Contact Name Apple Martine Jessica Marcinkevage
Title Director State Epidemiologist for Policy
and Practice
Address 615 Sheridan St, Port Townsend, PO Box 47890
WA 98368 Olympia, WA 98504-7890
Telephone # 360-385-9400
Email Address AMartine@co.jefferson.wa.us CEPEA@doh.wa.gov
IT Security Contact Scott Dewald John Weeks
Title Network Administrator Chief Information Security
Officer
Address PO Box 47890
Olympia, WA 98504-7890
Telephone # 360-999-3454
Email Address SDeWald@co.jefferson.wa.us Security@doh.wa.gov
Privacy Contact Name Veronica Shaw Mike Paul
Title Deputy Director DOH Chief Privacy Officer
Address P. 0. Box 47890
Olympia, WA 98504-7890
Telephone # 564-669-9692
Email Address veronica@co.jefferson.wa.us Privacy.officer@doh.wLgov
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DOH Contract # CLH27388
DEFINITIONS
Authorized user means a recipient's employees, agents, assigns, representatives, independent
contractors, or other persons or entities authorized by the data recipient to access, use or
disclose information through this agreement.
Authorized user agreement means the confidentiality agreement a recipient requires each of
its Authorized Users to sign prior to gaining access to Public Health Information.
Breach of confidentiality means unauthorized access, use or disclosure of information received
under this agreement. Disclosure may be oral or written, in any form or medium.
Breach of security means an action (either intentional or unintentional) that bypasses security
controls or violates security policies, practices, or procedures.
Confidential information means information that is protected from public disclosure by law.
There are many state and federal laws that make different kinds of information confidential. In
Washington State, the two most common are the Public Records Act RCW 42.56, and the
Healthcare Information Act, RCW 70.02.
Data storage means electronic media with information recorded on it, such as CDs/DVDs,
computers and similar devices.
Data transmission means the process of transferring information across a network from a
sender (or source), to one or more destinations.
Direct identifier Direct identifiers in research data or records include names; postal address
information ( other than town or city, state and zip code); telephone numbers, fax numbers, e-
mail addresses; social security numbers; medical record numbers; health plan beneficiary
numbers; account numbers; certificate /license numbers; vehicle identifiers and serial numbers,
including license plate numbers; device identifiers and serial numbers; web universal resource
locators ( URLs); internet protocol (IP) address numbers; biometric identifiers, including finger
and voice prints; and full face photographic images and any comparable images.
Disclosure means to permit access to or release, transfer, or other communication of
confidential information by any means including oral, written, or electronic means, to any party
except the party identified or the party that provided or created the record.
Encryption means the use of algorithms to encode data making it impossible to read without a
specific piece of information, which is commonly referred to as a "key". Depending on the type
of information shared, encryption may be required during data transmissions, and/or data
storage.
Human subjects research; human subject means a living individual about whom an investigator
(whether professional or student) conducting research obtains (1) data through intervention or
interaction with the individual, or (2) identifiable private information.
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Identifiable data or records contains information that reveals or can likely associate the
identity of the person or persons to whom the data or records pertain. Research data or
records with direct identifiers removed, but which retain indirect identifiers, are still considered
identifiable.
Limited dataset means a data file that includes potentially identifiable information. A limited
dataset does not contain direct identifiers.
Normal business hours are state business hours Monday through Friday from 8:00 a.m. to 5:00
p.m. except state holidays.
Potentially identifiable information means information that includes indirect identifiers which
may permit linking an individual to that person's health care information. Examples of
potentially identifiable information include:
• birth dates;
• admission,treatment or diagnosis dates;
• healthcare facility codes;
• other data elements that may identify an individual. These vary depending on
factors such as the geographical location and the rarity of a person's health
condition, age, or other characteristic.
Restricted confidential information means confidential information where especially strict
handling requirements are dictated by statutes, rules, regulations or contractual agreements.
Violations may result in enhanced legal sanctions.
State holidays Days of the week excluding weekends and state holidays; namely, New Year's
Day, Martin Luther King Jr. Day, President's Day, Memorial Day, Juneteenth, Labor Day,
Independence Day, Veterans' Day, Thanksgiving day, the day after Thanksgiving day, and
Christmas. Note: When January 1, June 19, July 4, November 11, or December 25 falls on
Saturday, the preceding Friday is observed as the legal holiday. If these days fall on Sunday, the
following Monday is the observed holiday.
GENERAL TERMS AND CONDITIONS
I. USE OF INFORMATION
The Information Recipient agrees to strictly limit use of information obtained or created
under this Agreement to the purposes stated in Exhibit I (and all other Exhibits
subsequently attached to this Agreement). For example, unless the Agreement specifies
to the contrary the Information Recipient agrees not to:
• Link information received under this Agreement with any other information.
• Use information received under this Agreement to identify or contact
individuals.
The Information Recipient shall construe this clause to provide the maximum protection
of the information that the law allows.
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II. SAFEGUARDING INFORMATION
A. CONFIDENTIALITY
Information Recipient agrees to:
• Follow dataset-specific suppression and aggregation requirements.
(Appendix A)
• Limit access and use of the information:
■ To the minimum amount of information.
■ To the fewest people.
■ For the least amount of time required to do the work.
• Ensure that all people with access to the information understand their
responsibilities regarding it.
• Ensure that every person (e.g., employee or agent) with access to the
information signs and dates the "Use and Disclosure of Confidential
Information Form" (Appendix A) before accessing the information.
■ Retain a copy of the signed and dated form as long as required in
Data Disposition Section.
The Information Recipient acknowledges the obligations in this section survive
completion, cancellation, expiration or termination of this Agreement.
B. SECURITY
The Information Recipient assures that its security practices and safeguards meet
Washington State Office of the Chief Information Officer (OCIO) security standard
141.10 Securing Information Technology Assets.
For the purposes of this Agreement, compliance with the HIPAA Security Standard
and all subsequent updates meets OICIO standard 141.10 "Securing Information
Technology Assets."
The Information Recipient agrees to adhere to the Data Security Requirements in
Appendix B. The Information Recipient further assures that it has taken steps
necessary to prevent unauthorized access, use, or modification of the information in
any form.
Note: The DOH Chief Information Security Officer must approve any changes to this
section prior to Agreement execution. IT Security Officer will send approval/denial
directly to DOH Contracts Office and DOH Business Contact.
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C. BREACH NOTIFICATION
The Information Recipient shall notify the DOH Chief Information Security Officer
(security@doh.wa.gov) within one (1) business days of any suspected or actual
breach of security or confidentiality of information covered by the Agreement.
Ill. RE-DISCLOSURE OF INFORMATION
Information Recipient agrees to not disclose in any manner all or part of the information
identified in this Agreement except as the law requires, this Agreement permits, or with
specific prior written permission by the Secretary of the Department of Health.
If the Information Recipient must comply with state or federal public record disclosure
laws, and receives a records request where all or part of the information subject to this
Agreement is responsive to the request: the Information Recipient will notify the DOH
Privacy Officer of the request ten (10) business days prior to disclosing to the requestor.
The notice must:
• Be in writing;
• Include a copy of the request or some other writing that shows the:
■ Date the Information Recipient received the request; and
■ The DOH records that the Information Recipient believes are
responsive to the request and the identity of the requestor,
if known.
IV. ATTRIBUTION REGARDING INFORMATION
Information Recipient agrees to cite "Washington State Department of Health" or other
citation as specified, as the source of the information subject of this Agreement in all
text, tables and references in reports, presentations and scientific papers.
Information Recipient agrees to cite its organizational name as the source of
interpretations, calculations or manipulations of the information subject of this
Agreement.
V. OTHER PROVISIONS
With the exception of agreements with British Columbia for sharing health information,
all data must be stored within the United States.
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VI. AGREEMENT ALTERATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such
amendments shall not be binding unless they are in writing and signed by personnel
authorized to bind each of the parties
VII. CAUSE FOR IMMEDIATE TERMINATION
The Information Recipient acknowledges that unauthorized use or disclosure of the
data/information or any other violation of sections II or III, and appendices A or B, may
result in the immediate termination of this Agreement.
Vill. CONFLICT OF INTEREST
The DOH may, by written notice to the Information Recipient:
Terminate the right of the Information Recipient to proceed under this Agreement if it is
found, after due notice and examination by the Contracting Office that gratuities in the
form of entertainment, gifts or otherwise were offered or given by the Information
Recipient, or an agency or representative of the Information Recipient, to any officer or
employee of the DOH, with a view towards securing this Agreement or securing
favorable treatment with respect to the awarding or amending or the making of any
determination with respect to this Agreement.
In the event this Agreement is terminated as provided in (a) above, the DOH shall be
entitled to pursue the same remedies against the Information Recipient as it could
pursue in the event of a breach of the Agreement by the Information Recipient. The
rights and remedies of the DOH provided for in this section are in addition to any other
rights and remedies provided by law. Any determination made by the Contracting
Office under this clause shall be an issue and may be reviewed as provided in the
"disputes" clause of this Agreement.
IX. DISPUTES
Except as otherwise provided in this Agreement, when a genuine dispute arises between
the DOH and the Information Recipient and it cannot be resolved, either party may
submit a request for a dispute resolution to the Contracts and Procurement Unit. The
parties agree that this resolution process shall precede any action in a judicial and quasi-
judicial tribunal. A party's request for a dispute resolution must:
• Be in writing and state the disputed issues, and
• State the relative positions of the parties, and
• State the information recipient's name, address, and his/her department
agreement number, and
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• Be mailed to the DOH contracts and procurement unit, P. O. Box 47905,
Olympia, WA 98504-7905 within thirty (30) calendar days after the party
could reasonably be expected to have knowledge of the issue which
he/she now disputes.
This dispute resolution process constitutes the sole administrative remedy available
under this Agreement.
X. EXPOSURE TO DOH BUSINESS INFORMATION NOT OTHERWISE PROTECTED BY LAW
AND UNRELATED TO CONTRACT WORK
During the course of this contract, the information recipient may inadvertently become
aware of information unrelated to this agreement. Information recipient will treat such
information respectfully, recognizing DOH relies on public trust to conduct its work. This
information may be hand written, typed, electronic, or verbal, and come from a variety
of sources.
XI. GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws
of the state of Washington and any applicable federal laws. The provisions of this
Agreement shall be construed to conform to those laws.
In the event of an inconsistency in the terms of this Agreement, or between its terms
and any applicable statute or rule, the inconsistency shall be resolved by giving
precedence in the following order:
• Applicable Washington state and federal statutes and rules;
• Any other provisions of the Agreement, including materials incorporated by
reference.
XII. HOLD HARMLESS
Each party to this Agreement shall be solely responsible for the acts and omissions of its
own officers, employees, and agents in the performance of this Agreement. Neither
party to this Agreement will be responsible for the acts and omissions of entities or
individuals not party to this Agreement. DOH and the Information Recipient shall
cooperate in the defense of tort lawsuits, when possible.
XIII. LIMITATION OF AUTHORITY
Only the Authorized Signatory for DOH shall have the express, implied, or apparent
authority to alter, amend, modify, or waive any clause or condition of this Agreement on
behalf of the DOH. No alteration, modification, or waiver of any clause or condition of
this Agreement is effective or binding unless made in writing and signed by the
Authorized Signatory for DOH.
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XIV. RIGHT OF INSPECTION
The Information Recipient shall provide the DOH and other authorized entities the right
of access to its facilities at all reasonable times, in order to monitor and evaluate
performance, compliance, and/or quality assurance under this Agreement on behalf of
the DOH.
XV. SEVERABILITY
If any term or condition of this Agreement is held invalid, such invalidity shall not affect
the validity of the other terms or conditions of this Agreement, provided, however, that
the remaining terms and conditions can still fairly be given effect.
XVI. SURVIVORSHIP
The terms and conditions contained in this Agreement which by their sense and context,
are intended to survive the completion, cancellation, termination, or expiration of the
Agreement shall survive.
XVII. TERMINATION
Either party may terminate this Agreement upon 30 days prior written notification to
the other party. If this Agreement is so terminated, the parties shall be liable only for
performance rendered or costs incurred in accordance with the terms of this Agreement
prior to the effective date of termination.
XVIII. WAIVER OF DEFAULT
This Agreement, or any term or condition, may be modified only by a written
amendment signed by the Information Provider and the Information Recipient. Either
party may propose an amendment.
Failure or delay on the part of either party to exercise any right, power, privilege or remedy
provided under this Agreement shall not constitute a waiver. No provision of this
Agreement may be waived by either party except in writing signed by the Information
Provider or the Information Recipient.
XIX. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s) contains all the terms and conditions agreed
upon by the parties. No other understandings, oral or otherwise, regarding the subject
matter of this Agreement and attached Exhibit(s) shall be deemed to exist or to bind any
of the parties hereto.
XX. PERIOD OF PERFORMANCE
This Agreement shall be effective from March 15, 2025 through _March 15, 2029
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the date of last
signature below.
INFORMATION PROVIDER INFORMATION RECIPIENT
State of Washington Department of Health Jefferson County Washington
for Jefferson County Public Health
Signature Signature
Heidi Eisenhour, Chair
Board of County Commissioners
Print Name Print Name
Date Date
Approved as to form only:
14Y for 01/24/2025
Philip C. Hunsucker, Date
Chief Civil Deputy Proscuting Attorney
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DOH Contract # CLH27388
EXHIBIT I
1. PURPOSE AND JUSTIFICATION FOR SHARING THE DATA
The Healthy Youth Survey (HYS) is a multi-agency collaborative research study conducted under
the authority of RCW 69.50.540 (1)(b)(i)(B). DOH and partner agencies are obligated to collect,
analyze, and report on survey results at least every two years. The HYS collects information
from 6th-12th graders in Washington on a range of health indicators that can inform programs
and policies related to adolescent health. Per RCW 43.70.050, these data will be shared for
appropriate use in alignment with all relevant protections as outlined in Appendix A.
HYS data will be used to support ongoing surveillance and policy and program evaluation efforts
related to adolescent wellbeing. Policy development may also be informed using these data.
The HYS has been approved by the Washington State Institutional Review Board (WSIRB). The
WSIRB authorizes DOH to release a full dataset to state, Tribal, and local public health partners
using the data to support surveillance and evaluation without further WSIRB review.
Data will be used for on-going assessment activities, including tracking trends for public health
indicators, preparing reports on specific public health issues, and responding to requests for
data from the public and other public agencies. Data are analysed and the findings reported to
Jefferson County leaderships, policy-makers, and other community partners to keep them
informed about emerging public health issues and to track the progress of various public health
programs.
Is the purpose of this agreement for human subjects research that requires Washington
State Institutional Review Board (WSIRB) approval?
❑ Yes ❑ No
If yes, has a WSIRB review and approval been received? If yes, please provide copy of
approval. If No, attach exception letter.
❑ Yes ❑ No
2. PERIOD OF PERFORMANCE
This Exhibit shall have the same period of performance as the Agreement unless otherwise
noted below:
Exhibit I shall be effective from through
3. DESCRIPTION OF DATA
Information Provider will make available the following information under this Agreement
(Include the name of the database and a list of all the data elements being provided):
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Healthy Youth Survey and all data elements as described in Appendix A.
The information described in this section is:
❑ Restricted Confidential Information (Category 4)
❑ Confidential Information (Category 3)
❑ Potentially identifiable information (Category 3)
❑ Internal [public information requiring authorized access] (Category 2)
❑ Public Information (Category 1)
Any reference to data/information in this Agreement shall be the data/information as
described in this Exhibit.
4. STATUTORY AUTHORITY TO SHARE INFORMATION
DOH statutory authority to obtain and disclose the confidential information or limited
Dataset(s) identified in this Exhibit to the Information Recipient:
RCW 43.70.050—Collection, use, and accessibility of health-related data
RCW 69.50.540 (1)(b)(i)(B)—Authority for conducting the Healthy Youth Survey
5. ACCESS TO INFORMATION
METHOD OF ACCESS/TRANSFER
❑ DOH Web Application (indicate application name):
❑ Washington State Secure File Transfer Service (mft.wa.gov)
❑ Encrypted CD/DVD or other storage device
❑ Health Information Exchange (HIE)**
❑ Other: (describe the methods for access/transfer)**
"Note: DOH Chief Information Security Officer must approve prior to Agreement
execution. DOH Chief Information Security Officer will send approval/denial directly to
DOH Contracts Office and DOH Business Contact.
FREQUENCY OF ACCESS/TRANSFER
❑ One time: DOH shall deliver information by (insert date)
® Repetitive: Between March 1, 2026 and March 15, 2029_
❑ As available within the period of performance stated in Section 2.
6. REIMBURSEMENT TO DOH
Payment for services to create and provide the information is based on the actual expenses
DOH incurs, including charges for research assistance when applicable.
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Billing Procedure
• Information Recipient agrees to pay DOH by check or account transfer within
30 calendar days of receiving the DOH invoice.
• Upon expiration of the Agreement, any payment not already made shall be
submitted within 30 days after the expiration date or the end of the fiscal
year, which is earlier.
Charges for the services to create and provide the information are:
❑ $
® No charge.
7. DATA DISPOSITION
Unless otherwise directed in writing by the DOH Business Contact, at the end of this
Agreement, or at the discretion and direction of DOH, the Information Recipient shall:
® Immediately destroy all copies of any data provided under this
Agreement after it has been used for the purposes specified in the
Agreement . Acceptable methods of destruction are described in
Appendix B. Upon completion, the Information Recipient shall submit
the attached Certification of Data Disposition (Appendix C) to the DOH
Business Contact.
❑ Immediately return all copies of any data provided under this Agreement
to the DOH Business Contact after the data has been used for the
purposes specified in the Agreement, along with the attached
Certification of Data Disposition (Appendix C)
❑ Retain the data for the purposes stated herein for a period of time not to
exceed (e.g., one year, etc.), after which Information
Recipient shall destroy the data (as described below) and submit the
attached Certification of Data Disposition (Appendix C) to the DOH
Business Contact.
❑ Other (Describe):
8. RIGHTS IN INFORMATION
Information Recipient agrees to provide, if requested, copies of any research papers or
reports prepared as a result of access to DOH information under this Agreement for DOH
review prior to publishing or distributing.
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In no event shall the Information Provider be liable for any damages, including, without
limitation, damages resulting from lost information or lost profits or revenue, the costs of
recovering such Information, the costs of substitute information, claims by third parties or
for other similar costs, or any special, incidental, or consequential damages, arising out of
the use of the information. The accuracy or reliability of the Information is not guaranteed
or warranted in any way and the information Provider's disclaim liability of any kind
whatsoever, including, without limitation, liability for quality, performance, merchantability
and fitness for a particular purpose arising out of the use, or inability to use the information.
® If checked, please submit the following:
Copies of All reports using HYS data to the attention of: Healthy Youth
Survey Principal Investigator at Healthy.Youth@doh.wa.gov
9. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s) contains all the terms and conditions agreed upon
by the parties. No other understandings, oral or otherwise, regarding the subject matter of
this Agreement and attached Exhibit(s) shall be deemed to exist or to bind any of the
parties hereto.
IN WITNESS WHEREOF, the parties have executed this Exhibit as of the date of last signature
below.
INFORMATION PROVIDER INFORMATION RECIPIENT
State of Washington Department of Health Jefferson County Washington
for Jefferson County Public Health
Signature Signature
Heidi Eisenhour, Chair
Board of County Commissioners
Print Name Print Name
Date Date
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APPENDIX A
USE AND DISCLOSURE OF CONFIDENTIAL INFORMATION
People with access to confidential information are responsible for understanding and following
the laws, policies, procedures, and practices governing it. Below are key elements:
A. CONFIDENTIAL INFORMATION
Confidential information is information federal and state law protects from public
disclosure. Examples of confidential information are social security numbers, and
healthcare information that is identifiable to a specific person under RCW 70.02. The
general public disclosure law identifying exemptions is RCW 42.56.
B. ACCESS AND USE OF CONFIDENTIAL INFORMATION
1. Access to confidential information must be limited to people whose work
specifically requires that access to the information.
2. Use of confidential information is limited to purposes specified elsewhere in this
Agreement.
C. DISCLOSURE OF CONFIDENTIAL INFORMATION
1. An Information Recipient may disclose an individual's confidential information
received or created under this Agreement to that individual or that individual's
personal representative consistent with law.
2. An Information Recipient may disclose an individual's confidential information,
received or created under this Agreement only as permitted under the Re-
Disclosure of Information section of the Agreement, and as state and federal
laws allow.
D. CONSEQUENCES OF UNAUTHORIZED USE OR DISCLOSURE
An Information Recipient's unauthorized use or disclosure of confidential information is
the basis for the Information Provider immediately terminating the Agreement. The
Information Recipient may also be subject to administrative, civil and criminal penalties
identified in law.
E. ADDITIONAL DATA USE RESTRICTIONS:
1. "Identifiable information" means any data element, or combinations of such data
elements, that could be used to identify an individual student who participated in
the Survey (such as grade, age, race, sex); presentations of data that could identify
individual students; and, in cases in which a school principal has not given
permission for school-identified presentations, individual schools or grade levels
within a school.
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Students participating in the survey and their parents were promised complete
anonymity of student survey responses. It is the intention of this agreement to
permit disclosure of individual-level Survey data while ensuring anonymity of
students.
2. "Survey' and "Survey' data refer to the Washington State Healthy Youth Survey
2002-2027.
The Healthy Youth Survey Planning Committee has requested that the Department of Health
(DOH, Data Provider) handle disclosure of individual-level data containing only indirect
identifiers from the Healthy Youth Survey 2002-2027 (hereinafter referred to as "Survey") to
local health departments and universities. WSIRB approval or exempt determination are not
needed for this data sharing agreement.
NOW THEREFORE, IT IS AGREED AS FOLLOWS:
1. For access to school identifiers, Jefferson County Public Health shall obtain written
permission from the principals of each school for Jefferson County Public Health
will report data in such a way that the school can be identified and written
permission from the superintendent of each school district for which Jefferson
County Public Health will report data in such a way that the school district can be
identified. School principal/superintendent permission will not be necessary to use
the data to compose groups of schools (e.g., north and south areas of the county)
as long as data are not reported in such a way that schools or school districts can
be identified. Generally, if there are at least 3 schools and 3 school districts at a
geographical level for which data are being reported, the schools and school
districts are not identifiable. However, there may be exceptions in which they
would be identifiable. For example, if the report includes thresholds that all of the
schools in a grouping meet (for example, if all schools or school districts in a
grouping have especially high or low levels of risk on a particular measure) then
the information for those schools or school districts is identifiable, and school
principal or superintendent permissions will be obtained.
2. DOH will disclose to Jefferson County Public Health individual-level Healthy Youth
Survey data for 2002-2027 survey cycles for the following geographic area(s): State
sample for all of Washington State, Jefferson County. DOH will disclose all data
elements including any geographic identifiers such as the identifiers of the schools
participating in the Survey in Jefferson County. Geographic identifiers will not be
provided for schools outside of Jefferson County. The Data Provider shall transfer
Survey data using a secure file transfer method.
3. Jefferson County Public Health (Data Recipient) will:
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a) use Survey data only to examine the use of alcohol, tobacco and other
drugs, and risk and protective factors, and other variables measured by the
survey, among public school students. These analyses will be used to
inform policy and program development at the local level;
b) maintain all Survey data in a secure, locked location, or in password
protected computer files, at all times when not in use;
c) restrict access to Survey data to persons who specifically require access in
the performance of their assigned duties. Prior to making Survey data
available, all staff requiring access will be informed of the use and
disclosure requirements and staff shall read and sign this agreement prior
to access. Jefferson County Public Health shall submit the signed
agreement to DOH.
d) Report or publish findings in a manner that does not permit identification
of students who participated in the Survey, which includes the following:
L Report or publish simple frequencies only if there are 15 or more
valid surveys, and
ii. Report or publish cross tabs only if there are at least 5 valid
responses per cell at the state level or 10 per cell at the sub-state
level.
4. Jefferson County Public Health will not:
a) attempt to identify any individual student who participated in the Survey or
use the Survey data for any personal reasons;
b) release, divulge, publish, transfer, sell or otherwise make known to
unauthorized persons identifiable Survey information;
c) copy, duplicate or otherwise retain Survey data provided or created under
this Agreement for any use after the stated purposes have been
accomplished.
d) transmit any Survey data across any electronic network or medium unless
the individual records have been securely encrypted.
e) use Survey data for any purposes other than those described in their
request to DOH.
Signed by all data users: /
Signatur Date
Print Name_Alyssa Wyrsch
Signature `` "� Date
Print Name_Lolinthea Hinkley
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APPENDIX B
DATA SECURITY REQUIREMENTS
Protection of Data
The storage of Category 3 and 4 information outside of the State Governmental Network
requires organizations to ensure that encryption is selected and applied using industry standard
algorithms validated by the NIST Cryptographic Algorithm Validation Program. Encryption must
be applied in such a way that it renders data unusable to anyone but authorized personnel, and
the confidential process, encryption key or other means to decipher the information is
protected from unauthorized access. All manipulations or transmissions of data within the
organizations network must be done securely.
The Information Recipient agrees to store information received under this Agreement (the
data) within the United States on one or more of the following media, and to protect it as
described below:
A. Passwords
1. Passwords must always be encrypted. When stored outside of the authentication
mechanism, passwords must be in a secured environment that is separate from the data
and protected in the same manner as the data. For example passwords stored on
mobile devices or portable storage devices must be protected as described under
section F. Data storage on mobile devices or portable storage media.
2. Complex Passwords are:
• At least 8 characters in length.
• Contain at least three of the following character classes: uppercase letters,
lowercase letters, numerals, special characters.
• Do not contain the user's name, user ID or any form of their full name.
• Do not consist of a single complete dictionary word but can include a passphrase.
• Do not consist of personal information (e.g., birthdates, pets' names, addresses,
etc.).
• Are unique and not reused across multiple systems and accounts.
• Changed at least every 120 days.
B. Hard disk drives— Data stored on workstation hard disks:
1. The data must be encrypted as described under section F. Data storage on mobile
devices or portable storage media. Encryption is not required when Potentially
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Identifiable Information is stored temporarily on local workstation Hard Disk
Drives/Solid State Drives. Temporary storage is thirty (30) days or less.
2. Access to the data is restricted to authorized users by requiring logon to the local
workstation using a unique user ID and Complex Password, or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards.
Accounts must lock after 5 unsuccessful access attempts and remain locked for at least
15 minutes, or require administrator reset.
C. Network server and storage area networks (SAN)
1. Access to the data is restricted to authorized users through the use of access control
lists which will grant access only after the authorized user has authenticated to the
network.
2. Authentication must occur using a unique user ID and Complex Password, or other
authentication mechanisms which provide equal or greater security, such as
biometrics or smart cards. Accounts must lock after 5 unsuccessful access attempts,
and remain locked for at least 15 minutes, or require administrator reset.
3. The data are located in a secured computer area, which is accessible only by
authorized personnel with access controlled through use of a key, card key, or
comparable mechanism.
4. If the servers or storage area networks are not located in a secured computer area
or if the data is classified as Confidential or Restricted it must be encrypted as
described under F. Data storage on mobile devices or portable storage media.
D. Optical discs (CDs or DVDs)
1. Optical discs containing the data must be encrypted as described under F. Data
storage on mobile devices or portable storage media.
2. When not in use for the purpose of this Agreement, such discs must be locked in a
drawer, cabinet or other physically secured container to which only authorized users
have the key, combination or mechanism required to access the contents of the
container.
E. Access over the Internet or the State Governmental Network (SGN).
1. When the data is transmitted between DOH and the Information Recipient, access is
controlled by the DOH, who will issue authentication credentials.
2. Information Recipient will notify DOH immediately whenever:
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a) An authorized person in possession of such credentials is terminated or
otherwise leaves the employ of the Information Recipient;
b) Whenever a person's duties change such that the person no longer requires
access to perform work for this Contract.
3. The data must not be transferred or accessed over the Internet by the Information
Recipient in any other manner unless specifically authorized within the terms of the
Agreement.
a) If so authorized the data must be encrypted during transmissions using a key
length of at least 128 bits. Industry standard mechanisms and algorithms,
such as those validated by the National Institute of Standards and
Technology (NIST) are required.
b) Authentication must occur using a unique user ID and Complex Password (of
at least 10 characters). When the data is classified as Confidential or
Restricted, authentication requires secure encryption protocols and multi-
factor authentication mechanisms, such as hardware or software tokens,
smart cards, digital certificates or biometrics.
c) Accounts must lock after 5 unsuccessful access attempts, and remain locked
for at least 15 minutes, or require administrator reset.
F. Data storage on mobile devices or portable storage media
1. Examples of mobile devices are: smart phones, tablets, laptops, notebook or netbook
computers, and personal media players.
2. Examples of portable storage media are: flash memory devices (e.g. USB flash drives),
and portable hard disks.
3. The data must not be stored by the Information Recipient on mobile devices or portable
storage media unless specifically authorized within the terms of this Agreement. If so
authorized:
a) The devices/media must be encrypted with a key length of at least 128 bits, using
industry standard mechanisms validated by the National Institute of Standards and
Technologies (NIST).
• Encryption keys must be stored in a secured environment that is separate
from the data and protected in the same manner as the data.
b) Access to the devices/media is controlled with a user ID and a Complex Password (of
at least 6 characters), or a stronger authentication method such as biometrics.
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c) The devices/media must be set to automatically wipe or be rendered unusable after
no more than 10 failed access attempts.
d) The devices/media must be locked whenever they are left unattended and set to
lock automatically after an inactivity activity period of 3 minutes or less.
e) The data must not be stored in the Cloud. This includes backups.
f) The devices/ media must be physically protected by:
• Storing them in a secured and locked environment when not in use;
• Using check-in/check-out procedures when they are shared; and
• Taking frequent inventories.
4. When passwords and/or encryption keys are stored on mobile devices or portable
storage media they must be encrypted and protected as described in this section.
G. Backup Media
The data may be backed up as part of Information Recipient's normal backup process
provided that the process includes secure storage and transport, and the data is encrypted
as described under F. Data storage on mobile devices or portable storage media.
H. Paper documents
Paper records that contain data classified as Confidential or Restricted must be protected by
storing the records in a secure area which is only accessible to authorized personnel. When
not in use, such records is stored in a locked container, such as a file cabinet, locking
drawer, or safe, to which only authorized persons have access.
I. Data Segregation
1. The data must be segregated or otherwise distinguishable from all other data. This is to
ensure that when no longer needed by the Information Recipient, all of the data can be
identified for return or destruction. It also aids in determining whether the data has or
may have been compromised in the event of a security breach.
2. When it is not feasible or practical to segregate the data from other data, then all
commingled data is protected as described in this Exhibit.
J. Data Disposition
If data destruction is required by the Agreement, the data must be destroyed using one or
more of the following methods:
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Data stored on: Is destroyed by:
Hard disks Using a "wipe" utility which will overwrite the data at
least three (3) times using either random or single
character data, or
Degaussing sufficiently to ensure that the data cannot
be reconstructed, or
Physically destroying the disk , or
Delete the data and physically and logically secure
data storage systems that continue to be used for the
storage of Confidential or Restricted information to
prevent any future access to stored information. One
or more of the preceding methods is performed
before transfer or surplus of the systems or media
containing the data.
Paper documents with On-site shredding, pulping, or incineration, or
Confidential or Restricted Recycling through a contracted firm provided the
information Contract with the recycler is certified for the secure
destruction of confidential information.
Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the
readable surface with a course abrasive.
Magnetic tape Degaussing, incinerating or crosscut shredding.
Removable media (e.g. floppies, Using a "wipe" utility which will overwrite the data at
USB flash drives, portable hard least three (3) times using either random or single
disks, Zip or similar disks) character data.
Physically destroying the disk.
Degaussing magnetic media sufficiently to ensure that
the data cannot be reconstructed.
K. Notification of Compromise or Potential Compromise
The compromise or potential compromise of the data is reported to DOH as required in
Section II.C.
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APPENDIX C
CERTIFICATION OF DATA DISPOSITION
Date of Disposition
❑ All copies of any Datasets related to agreement DOH# have been deleted from
all data storage systems. These data storage systems continue to be used for the
storage of confidential data and are physically and logically secured to prevent any
future access to stored information. Before transfer or surplus, all data will be
eradicated from these data storage systems to effectively prevent any future access to
previously stored information.
❑ All copies of any Datasets related to agreement DOH# have been eradicated
from all data storage systems to effectively prevent any future access to the previously
stored information.
❑ All materials and computer media containing any data related to agreement DOH
# have been physically destroyed to prevent any future use of the materials and
media.
❑ All paper copies of the information related to agreement DOH # have been
destroyed on-site by cross cut shredding.
❑ All copies of any Datasets related to agreement DOH # that have not been
disposed of in a manner described above, have been returned to DOH.
❑ Other
The data recipient hereby certifies, by signature below, that the data disposition requirements
as provided in agreement DOH # Section C, item B Disposition of Information, have
been fulfilled as indicated above.
Signature of data recipient Date
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