Forms

BHI has several methods with which to request custom data not otherwise available on our site.

To request aggregate or de-identified public health data, please complete our Online Data Request Form. 

NOTE: If the data you are requesting contains any of the following elements, the information you are requesting is considered confidential data and is subject to a data use agreement or IRB review prior to release.

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Research requests for vital records data (births and deaths) require approval from a panel of reviewers, including the State Registrar and the OPH Medical Director. The following forms should be completed and uploaded into the Online Data Request Form in order for us to obtain the proper approvals:

• Application for Vital Records Data (PDF)
• Application for Vital Records Data (DOC)
• Vital Records Confidentiality Assurance Statement
• Indemnification for Use of Vital Records Data
• And the appropriate list of fields being requested:
  • Birth Field Layout Form
  • Death Field Layout Form
  • Fetal Death Field Layout Form

If you are a researcher, your data request likely requires review by the LDH Institutional Review Board. Please visit the IRB website at www.dhh.la.gov/irb for information.

Any questions about these forms or requesting data from BHI should be emailed to cphi@la.gov.