Appendix A: Expert Determination Template

HIPAA covered entities in CHHS must de-identify data in compliance with the HIPAA standard. Under the HIPAA standard, either Safe Harbor or Expert Determination must be used. If Expert Determination is used then the documentation of the review is essential. The following may serve as a template for this documentation with the reference to the CHHS DDG to support the analysis documented.

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Documentation of Expert Determination Template Name of Report:

Reason for Data Release:

Identify why the data release does not meet Safe Harbor. For example:

The request does not meet the Safe Harbor standard because it includes counts by county (geographic area smaller than the state) or counts by month (which does not meet the criteria for dates). Therefore, the steps in the CHHS DDG are being used to assess the tables.

Document how the conditions of each step are met or not met	Result
Step 1 – Presence of Personal Characteristics Summary:
Step 2 – Numerator Denominator Condition Summary:
Step 3 – Assess Potential Risk Summary:
Step 4 – Statistical Masking Summary:
Step 5 – Expert Review Summary: “Risk is very small that the information could be used, alone or in combination with other reasonably available information, by an anticipated recipient to identify an individual who is a subject of the information”