Data Request Forms

The Bureau of Health Informatics (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. 

Notice for Media Inquiries and Journalists: 
If you are a reporter or journalist seeking information, please do not use this data request form. All media and public information requests should be submitted through the Public Records Request process for proper handling. To ensure your request is directed to the appropriate team, please visit our Public Records Request page to submit your inquiry.

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:

• Name
• Any location smaller than a state
• All dates directly related to an individual
• Telephone numbers
• Fax numbers
• Email addresses
• Social Security Numbers
• Medical record numbers
• Health plan numbers
• Account numbers
• Certificate/license numbers
• Vehicle identifiers, license plate or serial numbers
• Device identifiers or serial numbers
• URLs
• IP Address numbers
• Biometric identifiers, including fingerprints and voiceprints
• Full-face or any comparable images
• Any other unique identifying number or factor

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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 to 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.