Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
University of Utah (NEMSIS) DUA Page 1 of 15 NEMSIS DATA USE AGREEMENT This Data Use Agreement (hereinafter, the “Agreement”) is entered into this _____ day of _____________________, 2016 between the National EMS Information System Technical Assistance Center (hereinafter, “NEMSIS” or “Data Recipient”) in the Department of Pediatrics at the University of Utah School of Medicine, acting as an agent of NHTSA (Office of EMS) under contract number DTNH2215C00030, and the _____State or Territory EMS Office____ (“Covered Entity”) for purposes of compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, and the Paperwork Reduction Act OMB Control Number: 2127-0717. RECITALS A Whereas, Data Recipient performs certain operations including the collection of EMS incident data in order to populate a National Emergency Medical Services (EMS) Database; and B. Whereas, Covered Entity is engaged in activities including the collection of EMS activation, response, and care data; and C. Whereas, Covered Entity agrees to disclose a Limited Data Set (as defined in Appendix A) to Data Recipient for use by Data Recipient in performing the Activities (as defined below); and D. Whereas, Data Recipient agrees to limit its use of the Limited Data Set and protect the Limited Data Set according to the terms and conditions of this Agreement, and all applicable requirements of HIPAA, HITECH, and the Privacy Rule (as defined below), as amended from time to time. THEREFORE, in consideration of the mutual promises set forth herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties agree as follows: ARTICLE 1 DEFINITIONS “Agreement” means this document. “Contractors” means agents, contractors and subcontractors. “Data Recipient” means NEMSIS and its authorized employees acting within the scope of their duties. “Deidentified Health Information” means any information not identified as “Protected Health Information” from the Electronic Protected Health Information and shall include any information that cannot be associated with any individual in a manner that could identify the individual. “Effective Date” means the date on which the last party executes this Agreement. University of Utah (NEMSIS) DUA Page 2 of 15 “Electronic Protected Health Information” means the term “electronic health information” in 45 CFR § 160.103, limited to information created, received, maintained or transmitted by Covered Entity to Data Recipient. “EMS” means Emergency Medical Services. “HIPAA” means the Health Information Portability and Accountability Act of 1996. “HITECH” means the Health Information Technology for Economic and Clinical Health Act of 2009 “Individual” means the person who is the subject of information collected, used, or disclosed by the Covered Entity. “Limited Data Set” means the data related to the NEMSIS data set in Appendix A. “National Emergency Medical Services Database” means the collection of pre-hospital data collected and maintained by NEMSIS. “NEMSIS” means the National EMS Information System. “NEMSIS TAC” means the National Emergency Medical Services Information Center – Technical Assistance Center. “Pre-hospital data system” means the information from an EMS incident and patient care data created by EMSPs and then submitted to Data Recipient. “Privacy Rule” means the Standards for Privacy of Individual Identifiable Health Information at 45 CFR parts 160, 162 and 164 subparts A and E. “Protected Health Information” has the meaning given that term in HIPAA. “Required by Law” mean the term “required by law” in 45 CFR § 164.501. “Secretary” means the Secretary of the Department of Health and Human Services or his/her designee. ARTICLE 2 DISCLOSURE OF LIMITED DATA SET TO DATA RECIPIENT 2.1 Scope of Limited Data Set. For purposes of this Agreement, the Limited Data Set shall consist of the health information from the NEMSIS data subset described in Appendix A of Covered Entity’s prehospital data system. 2.2 Disclosure of Limited Data Set. Covered Entity agrees to disclose the Limited Data Set to Data Recipient solely for use in connection with Data Recipient’s responsibility to populate a National EMS Database with data from states and territories from around the United States and related activities University of Utah (NEMSIS) DUA Page 3 of 15 and Data Recipient agrees that it shall not use the Limited Data Set for any other purpose. Data Recipient further agrees that Data Recipient shall limit access to and the use of the Limited Data Set to the following individuals or classes of individuals who need the Limited Data Set in performing the Activities: See Appendix B for a List of Individuals and classes of Individuals. ARTICLE 3 OBLIGATIONS OF DATA RECIPIENT 3.1. Use of Limited Data Set. Data Recipient shall not use or disclose the Limited Data Set except as permitted under the terms of this Agreement or as required by law. 3.2 Safeguards Against Misuse of Information. Data Recipient shall use appropriate safeguards to prevent use or disclosure of the Limited Data Set other than as permitted under this Agreement. 3.3 Reporting of Disclosures of Protected Health Information. Data Recipient shall notify Covered Entity in writing of any use or disclosure of the Limited Data Set in violation of this Agreement by Data Recipient, its officers, directors, employees, contractors or agents, or by any third party, within one day of Data Recipient having knowledge of any such violation. 3.4 Use of Limited Data Set by Third Parties. Data Recipient shall ensure that its agents, contractors and subcontractors (collectively “Contractors”) to whom it provides any portion of the Limited Data Set shall comply with all restrictions and conditions that apply to Data Recipient with respect to the use of the Limited Data Set and that no Contractor shall use or disclose such information except as permitted under the terms of this Agreement or as required by law. Data Recipient further agrees that it shall obtain and maintain, throughout the term of this Agreement, an agreement with each Contractor that has or will have access to the Limited Data Set by or through Data Recipient, under which such Contractor agrees to be bound by the same restrictions, terms and conditions that apply to Data Recipient pursuant to this Agreement. 3.5 Identity of Individuals. Data Recipient agrees not to use the Limited Data Set in such a way as to identify any individual and further agrees not to contact any individual who may be a subject within the Limited Data Set. 3.6 Minimum Necessary Information. Data Recipient represents that Data Recipient’s request that Covered Entity disclose Protected Health Information to Data Recipient is limited in scope to the minimum Protected Health Information necessary to accomplish Data Recipient’s purpose in connection with the Activities. 3.7 Notice of Request for Data. Data Recipient agrees to notify Covered Entity within five business days of Data Recipient’s receipt of any request or subpoena for Protected Health Information relating to this Agreement. Such notice shall be in writing and may be sent by fax or email provided that any such notice shall also be sent to Covered Entity by personal delivery, certified mail, return receipt requested, or by nationally recognized overnight carrier to the following: University of Utah (NEMSIS) DUA Page 4 of 15 Covered Entity Name Department Address City, State, Zip Code Phone Number Fax Number Email . To the extent that Covered Entity decides to assume responsibility for challenging the validity of such request, Data Recipient shall cooperate fully with Covered Entity in any such challenge. ARTICLE 4 OWNERSHIP OF INFORMATION Data Recipient acknowledges that, as between Data Recipient and Covered Entity, all Protected Health Information received or developed by Data Recipient in connection with this Agreement shall be and remain the sole property of Covered Entity, including any and all derivatives thereof developed by Data Recipient in performing its obligations under this Agreement. ARTICLE 5 TERM AND TERMINATION 5.1 Term. The term of this Agreement shall commence as of the effective date set forth herein and shall terminate when all of the Protected Health Information provided by Covered Entity to Data Recipient, or created or received by Data Recipient on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is not feasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this section. 5.2 Termination for Cause. Upon Covered Entity’s knowledge of a material breach by Data Recipient, Covered Entity shall: (a) Provide Data Recipient with written notice of the breach and an opportunity to cure the breach within 30 calendar days of receipt of such notice. Data Recipient shall immediately take steps to mitigate the breach and shall cure the breach within the 30 day notice period. If Data Recipient fails to mitigate and cure the breach within the notice period, Covered Entity may immediately terminate this Agreement; or (b) Immediately terminate this Agreement (without opportunity to cure) if Covered Entity determines, in Covered Entity’s sole discretion, that Data Recipient has breached a material term of this Agreement; and/or (c) Covered Entity shall report the violation to the Secretary. University of Utah (NEMSIS) DUA Page 5 of 15 5.3 Effect of Termination. Upon termination of this Agreement, Data Recipient shall, upon the request of Covered Entity, either return or destroy all Protected Health Information received from Covered Entity, or created or received by Data Recipient on behalf of Covered Entity, and thereafter Data Recipient shall not retain any copies of such Protected Health Information. Notwithstanding the foregoing, to the extent that Covered Entity agrees that it is not feasible to return or destroy such Protected Health Information, the terms and provisions of this Agreement shall survive termination of the Agreement and such Protected Health Information shall be used or disclosed solely for such purpose or purposes that prevented the return or destruction of such Protected Health Information. ARTICLE 6 INDEMNIFICATION Covered Entity and Data Recipient shall each defend, indemnify and hold harmless the other from and against any and all claims, losses, causes of action, judgments, damages and expenses including, but not limited to attorney’s fees, to the extent caused by or arising out of any breach of this Agreement or failure to perform the obligations hereunder, by the indemnifying party, its employees, officers, volunteers or Contractors. The indemnity obligations set forth in this Article 6 shall survive termination of this Agreement. ARTICLE 7 INJUNCTIVE RELIEF Data Recipient agrees that the remedies at law for any breach by it of the terms of this Agreement may be inadequate and that monetary damages from any such breach may not be sufficient or readily measured. Accordingly, in the event of any breach or threatened breach by Data Recipient of any terms of this Agreement, Covered Entity shall be entitled to immediate injunctive relief. Covered Entity’s right to injunctive relief shall be cumulative and nothing herein shall prohibit Covered Entity from seeking all other available remedies. ARTICLE 8 GENERAL PROVISIONS 8.1 Singular case means the plural and plural includes the singular. 8.2 Any alterations, modifications, or waivers of the provisions of this Agreement may be made by a joint amendment directing the change and signed by both Covered Entity and Data Recipient. 8.3 Failure of Covered Entity to require strict performance of any term or condition of this Agreement shall not be deemed to be a waiver of any subsequent breach or default of any term or condition. 8.4 Effect. The terms and provisions of this Agreement shall supersede any other conflicting or inconsistent agreements between Covered Entity and Data Recipient, including without limitation all University of Utah (NEMSIS) DUA Page 6 of 15 exhibits and all documents incorporated herein by reference. Any limitation of liability or exclusion of damages provisions in any other agreement shall not be applicable to this Agreement. 8.5 Amendment. Data Recipient and Covered Entity agree to amend this Agreement to the extent and whenever necessary to allow either party to comply with the Privacy Rule, the Standards for Electronic Transactions (45 CFR Parts 160 and 162) and the Security Standards (45 CFR Part 142) (collectively, the “Standards”) promulgated or to be promulgated by the Secretary or other regulations or statutes. Data Recipient agrees that it will fully comply with all such Standards and that it will agree to amend this Agreement to incorporate any material changes required by the Standards. 8.6 Any legal notice or other communication required or permitted hereunder with Covered Entity shall be in writing, and will be deemed given when delivered personally, sent by confirmed fax, sent by commercial overnight courier (with written verification of receipt) or sent by registered or certified mail, return receipt requested, postage prepaid. All communications shall be sent to the attention of the persons listed on the signature page or their successor of this Agreement and at the addresses or fax numbers set forth below unless other names, addresses or fax numbers are provided by either or both parties, with copies of all such legal notices or other communications delivered in accordance herewith to the following: Covered Entity Name Department Address City, State, Zip Code Contact Person Title Phone Email University of Utah (NEMSIS) DUA Page 7 of 15 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives effective as of the day and year set forth herein. University of Utah School of Medicine (“Data Recipient”) By: _________________________________ Date: _______________________ (Signature) Name: _______________________________ (Please Print) Title: ________________________________ Covered Entity - Name (“Covered Entity”) By: _________________________________ (Signature) Name: _______________________________ (Please Print) Title: ________________________________ Date: _______________________ University of Utah (NEMSIS) DUA Page 8 of 15 Appendix A – Limited DataSet The NEMSIS Version 3 National EMS Elements To Be Collected from the Covered Entity (State or Territory) The NHTSA / NEMSIS Version 3 standard consists of two Datasets: the Demographic (EMS Agency Information) (DEM DataSet) and EMS (ePCR/Event) (EMS DataSet). The national subsets of requisite data [Limited Dataset] are the only elements that are sent from a State or Territory (Covered Entity) to populate the NEMSIS Database at the NEMSIS Technical Assistance Center. The DEM DataSet represents information regarding the EMS Agency. The EMS DataSet represents information regarding the EMS activation / response. This may or may not include detailed incident, scene, patient, assessment, and treatment information depending on the disposition of the incident and/or patient. NHTSA / NEMSIS Version 3 – Requisite National Elements - Demographic DataSet The NHTSA / NEMSIS Version 3 National Subset of data elements for the Demographic (EMS Agency) submission is listed below. 35 elements comprise the Demographic Dataset (DEM DataSet). The three elements with a grey background will be submitted with details by the State Data Collection System to populate the NEMSIS Database. The 32 remaining elements are specific to the EMS Agency based on its structure and the licensure granted by the State EMS Office or other licensing authority. Blue typeface indicates the elements will be removed from public reporting. NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name Elements Removed from Public Reporting DEMOGRAPHIC (EMS Agency) REPORT Information dAgency Information 1 2 3 4 5 6 7 8 9 10 11 12 13 dAgency.01 dAgency.02 dAgency.04 dAgency.05 dAgency.06 dAgency.07 dAgency.08 dAgency.09 dAgency.11 dAgency.12 dAgency.13 dAgency.14 dAgency.15 EMS Agency Unique State ID EMS Agency Number EMS Agency State EMS Agency Service Area States EMS Agency Service Area County(ies) EMS Agency Census Tracts EMS Agency Service Area ZIP Codes Primary Type of Service Level of Service Organization Status Organizational Type EMS Agency Organizational Tax Status Statistical Calendar Year Removed Removed Removed Removed Removed Removed Removed Public Data Public Data Public Data Public Data Removed Removed University of Utah (NEMSIS) DUA Page 9 of 15 14 15 16 17 18 19 20 21 NHTSA / NEMSIS V3 Element Number dAgency.16 dAgency.17 dAgency.18 dAgency.19 dAgency.20 dAgency.21 dAgency.25 dAgency.26 NHTSA / NEMSIS V3 Element Name Total Primary Service Area Size Total Service Area Population 911 EMS Call Center Volume per Year EMS Dispatch Volume per Year EMS Patient Transport Volume per Year EMS Patient Contact Volume per Year National Provider Identifier Fire Department ID Number Elements Removed from Public Reporting Removed Removed Removed Removed Removed Removed Removed Removed dConfiguration Information - This group repeats to allow for EMS Agencies licensed in multiple states to document the information specific to each state requirements. 22 23 24 25 26 dConfiguration.01 dConfiguration.02 dConfiguration.03 dConfiguration.04 dConfiguration.05 State Associated with the Certification/Licensure Levels State Certification/Licensure Levels Procedures Permitted by the State Medications Permitted by the State Protocols Permitted by the State Public Data Public Data Public Data Public Data Public Data 27 dConfiguration.06 28 dConfiguration.07 EMS Certification Levels Permitted to Perform Each Procedure EMS Agency Procedures Removed Removed 29 30 31 32 dConfiguration.08 dConfiguration.09 dConfiguration.10 dConfiguration.11 EMS Certification Level Permitted to Administer Each Medication EMS Agency Medications EMS Agency Protocols EMS Agency Specialty Service Capability Removed Removed Removed Removed 33 dConfiguration.13 34 dConfiguration.15 35 dConfiguration.16 Emergency Medical Dispatch (EMD) Provided to EMS Agency Service Area Patient Monitoring Capability(ies) Crew Call Sign Removed Removed Removed University of Utah (NEMSIS) DUA Page 10 of 15 NHTSA / NEMSIS Version 3 – Requisite National Elements - EMS DataSet The NHTSA / NEMSIS Version 3 National Subset of data elements for the EMS Incident / Patient Care Report (ePCR/Event or EMS DataSet) submission are listed below. A total of 133 elements comprise the EMS Incident / Patient Care Report Dataset (EMS DataSet). Three demographic (DEM DataSet) elements make up the header information specific to the EMS Agency. The actual ePCR/Event information consists of 130 elements (NEMSIS v3.4.0). Blue typeface indicates the elements will be removed from public reporting. NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name Elements Removed from Public Reporting HEADER - Demographic EMS Agency Information Group 1 dAgency.01 EMS Agency Unique State ID 2 dAgency.02 3 dAgency.04 EMS Agency Number EMS Agency State Removed Removed Removed INCIDENT / PATIENT CARE REPORT (ePCR/Event) Information Group eRecord Information 1 2 3 4 eRecord.01 eRecord.02 eRecord.03 eRecord.04 Patient Care Report Number Software Creator Software Name Software Version Removed Removed Removed Removed eResponse Information 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 eResponse.01 eResponse.03 eResponse.04 eResponse.05 eResponse.07 eResponse.08 eResponse.09 eResponse.10 eResponse.11 eResponse.12 eResponse.13 eResponse.14 eResponse.15 eResponse.23 eResponse.24 EMS Agency Number Incident Number EMS Response Number Type of Service Requested Primary Role of the Unit Type of Dispatch Delay Type of Response Delay Type of Scene Delay Type of Transport Delay Type of Turn-Around Delay EMS Vehicle (Unit) Number EMS Unit Call Sign Level of Care of This Unit Response Mode to Scene Additional Response Mode Descriptors Removed Removed Removed Public Data Public Data Public Data Public Data Public Data Public Data Public Data Removed Removed Public Data Public Data Public Data University of Utah (NEMSIS) DUA Page 11 of 15 NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name Elements Removed from Public Reporting eDispatch Information 20 eDispatch.01 21 eDispatch.02 Complaint Reported by Dispatch EMD Performed Public Data Public Data PSAP Call Date/Time Unit Notified by Dispatch Date/Time Unit En Route Date/Time Unit Arrived on Scene Date/Time Arrived at Patient Date/Time Unit Left Scene Date/Time Patient Arrived at Destination Date/Time Destination Patient Transfer of Care Date/Time Unit Back in Service Date/Time Public Data Public Data Public Data Public Data Public Data Public Data Public Data Patient’s Home County Patient’s Home State Patient’s Home ZIP Code Gender Race Age Age Units Removed Removed Removed Public Data Public Data Public Data Public Data Primary Method of Payment CMS Service Level Public Data Public Data First EMS Unit on Scene Number of Patients at Scene Mass Casualty Incident Triage Classification for MCI Patient Incident Location Type Incident State Incident ZIP Code Incident County Public Data Public Data Public Data Public Data Public Data Removed Removed Removed Date/Time of Symptom Onset Possible Injury Chief Complaint Anatomic Location Public Data Public Data Public Data eTimes Information 22 23 24 25 26 27 28 eTimes.01 eTimes.03 eTimes.05 eTimes.06 eTimes.07 eTimes.09 eTimes.11 29 eTimes.12 30 eTimes.13 Public Data Public Data ePatient Information 31 32 33 34 35 36 37 ePatient.07 ePatient.08 ePatient.09 ePatient.13 ePatient.14 ePatient.15 ePatient.16 ePayment Information 38 ePayment.01 39 ePayment.50 eScene Information 40 41 42 43 44 45 46 47 eScene.01 eScene.06 eScene.07 eScene.08 eScene.09 eScene.18 eScene.19 eScene.21 eSituation Information 48 eSituation.01 49 eSituation.02 50 eSituation.07 University of Utah (NEMSIS) DUA Page 12 of 15 51 52 53 54 55 56 NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name eSituation.08 eSituation.09 eSituation.10 eSituation.11 eSituation.12 eSituation.13 Chief Complaint Organ System Primary Symptom Other Associated Symptoms Provider’s Primary Impression Provider’s Secondary Impressions Initial Patient Acuity Elements Removed from Public Reporting Public Data Public Data Public Data Public Data Public Data Public Data eInjury Information 57 eInjury.01 58 eInjury.03 59 eInjury.04 Cause of Injury Trauma Center Criteria Vehicular, Pedestrian, or Other Injury Risk Factor Public Data Public Data Cardiac Arrest Cardiac Arrest Etiology Resuscitation Attempted By EMS Arrest Witnessed By CPR Care Provided Prior to EMS Arrival AED Use Prior to EMS Arrival Type of CPR Provided First Monitored Arrest Rhythm of the Patient Any Return of Spontaneous Circulation Date/Time of Cardiac Arrest Reason CPR/Resuscitation Discontinued Cardiac Rhythm on Arrival at Destination End of EMS Cardiac Arrest Event Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Barriers to Patient Care Alcohol/Drug Use Indicators Public Data Public Data Date/Time Vital Signs Taken Obtained Prior to this Unit’s EMS Care Cardiac Rhythm / Electrocardiography (ECG) ECG Type Method of ECG Interpretation SBP (Systolic Blood Pressure) Method of Blood Pressure Measurement Heart Rate Pulse Oximetry Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data eArrest Information 60 61 62 63 64 65 66 67 68 69 70 71 72 eArrest.01 eArrest.02 eArrest.03 eArrest.04 eArrest.05 eArrest.07 eArrest.09 eArrest.11 eArrest.12 eArrest.14 eArrest.16 eArrest.17 eArrest.18 eHistory Information 73 eHistory.01 74 eHistory.17 eVitals Information 75 76 77 78 79 80 81 82 83 eVitals.01 eVitals.02 eVitals.03 eVitals.04 eVitals.05 eVitals.06 eVitals.08 eVitals.10 eVitals.12 University of Utah (NEMSIS) DUA Page 13 of 15 84 85 86 87 88 89 90 91 92 93 94 95 NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name eVitals.14 eVitals.16 eVitals.18 eVitals.19 eVitals.20 eVitals.21 eVitals.22 eVitals.26 eVitals.27 eVitals.29 eVitals.30 eVitals.31 Respiratory Rate End Tidal Carbon Dioxide (ETCO2) Blood Glucose Level Glasgow Coma Score-Eye Glasgow Coma Score-Verbal Glasgow Coma Score-Motor Glasgow Coma Score-Qualifier Level of Responsiveness (AVPU) Pain Scale Score Stroke Scale Score Stroke Scale Type Reperfusion Checklist Elements Removed from Public Reporting Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data eProtocols Information 96 eProtocols.01 97 eProtocols.02 Protocols Used Protocol Age Category Public Data Public Data Date/Time Medication Administered Medication Administered Prior to this Unit’s EMS Care Medication Given Medication Dosage Medication Dosage Units Response to Medication Medication Complication Role/Type of Person Administering Medication Public Data Date/Time Procedure Performed Procedure Performed Prior to this Unit’s EMS Care Procedure Number of Procedure Attempts Procedure Successful Procedure Complication Response to Procedure Role/Type of Person Performing the Procedure Public Data eMedications Information 98 eMedications.01 99 100 101 102 103 104 eMedications.02 eMedications.03 eMedications.05 eMedications.06 eMedications.07 eMedications.08 105 eMedications.10 Public Data Public Data Public Data Public Data Public Data Public Data Public Data eProcedures Information 106 eProcedures.01 107 108 109 110 111 112 eProcedures.02 eProcedures.03 eProcedures.05 eProcedures.06 eProcedures.07 eProcedures.08 113 eProcedures.10 Public Data Public Data Public Data Public Data Public Data Public Data Public Data University of Utah (NEMSIS) DUA Page 14 of 15 NHTSA / NEMSIS V3 Element Number NHTSA / NEMSIS V3 Element Name Elements Removed from Public Reporting eDisposition Information 114 115 116 117 118 119 120 121 122 123 124 125 eDisposition.05 eDisposition.06 eDisposition.07 eDisposition.12 eDisposition.16 eDisposition.17 eDisposition.18 eDisposition.19 eDisposition.20 eDisposition.21 eDisposition.22 eDisposition.23 126 eDisposition.24 127 eDisposition.25 Destination State Destination County Destination ZIP Code Incident/Patient Disposition EMS Transport Method Transport Mode from Scene Additional Transport Mode Descriptors Final Patient Acuity Reason for Choosing Destination Type of Destination Hospital In-Patient Destination Hospital Capability Destination Team Pre-Arrival Alert or Activation Date/Time of Destination Prearrival Alert or Activation Removed Removed Removed Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Public Data Emergency Department Disposition Hospital Disposition Public Data Public Data Suspected EMS Work Related Exposure, Injury, or Death Public Data Public Data Public Data eOutcome Information 128 eOutcome.01 129 eOutcome.02 eOther Information 130 eOther.05 Note: Element eArrest.10 - Therapeutic Hypothermia Initiated, was retired from the NEMSIS Version 3 Standard in March 2015 with the Version 3.4.0 release. The information can be documented by use of the procedure “hypothermia induction therapy” in eProcedure.03. The element eArrest.10 was part of the national requisite elements for previous versions of the NHTSA / NEMSIS 3 standard. If the Covered Entity is collecting, receiving, and processing data based on the v3.3.4 standard this element should still be collected and submitted to the NEMSIS Database. University of Utah (NEMSIS) DUA Page 15 of 15 Appendix B Disclosure of Limited Data Set By Means of the National EMS Database For the purposes of using the data subset from the Covered Entities (States and Territories), the following individuals or classes of individuals will have access to different levels of data: All Data Sent by all Covered Entities (States and Territories) in its Raw Format University of Utah, Health Sciences Center, National EMS Information System Technical Assistance Center (NEMSIS TAC) National Highway Traffic Safety Administration (NHTSA) Office of EMS or the NHTSA National Center for Statistics and Analysis Data Sent By the Covered Entity (State or Territory) and Used by the National EMS Database Reporting Engine. EXCLUSIONS: None; includes all data submitted by each specific Covered Entity. The above entities The Entity (State), Office of Emergency Medical Services Data Sent By the Covered Entity (State or Territory) and Used by the National EMS Database Reporting Engine. EXCLUSIONS: Any elements identifying a patient, zip code elements, EMS provider/agency, or receiving hospital (listed above in blue typeface and documented as “Removed” in Appendix A). The above entities The public that can access the de-identified National EMS Database Reporting Tools on the NEMSIS TAC website.