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. 

If you are an employee of DHH or a DHH contractor and are requesting access to a public health database, please complete and sign the Interoffice Request for Access to Confidential Data form and return to cphi@la.gov.

If you are an employee of DHH or a DHH contractor and are requesting data be pulled and sent to you, please use our Internal Data Request Form.

If you are an employee of another state agency, a parish or city government, or a member of the public and are requesting confidential data (see box below), a data use agreement must be executed before the data can be released. To provide the information required for a DUA, please complete and sign the External Request for Use of Confidential Data form and return to cphi@la.gov.

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.

  1. Name
  2. Any location smaller than a state
  3. All dates directly related to an individual
  4. Telephone numbers
  5. Fax numbers
  6. E-mail address
  7. Social security numbers
  8. Medical record numbers
  9. Health plan numbers
  10. Account numbers
  11. Certificate/license numbers
  12. Vehicle identifiers, license plate or serial numbers
  13. Device identifiers or serial numbers
  14. URLs
  15. IP address numbers
  16. Biometric identifiers, including fingerprints and voiceprints
  17. Full-face or any comparable images
  18. Any other unique identifying number

 

 

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.