Data Request and Utilization Agreement FormLast updated February 21, 2013 (178 KB)
Use this form to request summary data or a limited data set from the Alaska Section of Epidemiology. Requests will be considered based on SOE policy. Please note that submission of this form does not guarantee release of data.
DHSS Request for Access to PHI FormLast updated December 18, 2009 (55 KB)
Request for access by a patient or authorized representative to data held by DHSS will generally be granted, although a number of exceptions exist and are described in detail in DHSS Policy and Procedure #709. All requests for access to information by a patient or a patient representative must be in writing, using the DHSS Request for Access to PHI Form. SOE will respond to such requests within the required time frame of 30 days.