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[]
[]
[null,"Data Request Form"]
[null,"This form is to be completed when requesting information collected under the Health Services Act 2016. "]
[null,"This is a dynamic form that will prompt for further information based upon responses provided. All sections need to be completed to inform a full and proper assessment of this request."]
[]
[null,"Part A: Requestor Information"]
[null,"Requestor Details"]
[null,"Name"]
[null,"Position"]
[null,"Institution / Organisation","(Please select...)"]
[null,"Institution Name"]
[null,"Institution location if outside WA","(Please select...)"]
[null,"Phone"]
[null,"Email"]
[]
[null,"Part B: Data Request"]
[null,"Request Details"]
[null,"Project summary","(Please provide context for your request including why the data is required.)"]
[null,"Details of information required ","Please specify your cohort of interest, including time period of data, any inclusions/exclusions and disaggregation required e.g., financial year, hospital region."]
[null,"Identifiability of information being requested","(Please select...)"]
[null,"Participant consent arrangements","(Please select...)"]
[null,"Please describe how the disclosure of the information is reasonably necessary for the purpose for which it is to be disclosed","(Please provide further details)"]
[null,"Please describe how the purpose for which the information is to be disclosed cannot be achieved by providing information that is not personal information","(Please provide further details)"]
[null,"Please describe how it is impracticable to obtain the consent of the individual to whom the information relates","(Please provide further details)"]
[null,"Information Source / \nData Collection","(Please list the information source(s)/data collection(s) required)"]
[null,"Granularity of information","(Please select...)"]
[null,"Frequency of information required","(Please select...)"]
[null,"What is the purpose of this request?","(Please select...)"]
[null,null,"Please visit: www.healthywa.wa.gov.au/FOI "]
[null,"Please elaborate on the purpose of this request?","(Please provide further details)"]
[null,"Has Human Research Ethics Committee (HREC) approval been obtained?","(Please select...)"]
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select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please 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select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)","(Please select...)"]
[null,"Who will have access to the information?","(Please list the people/organisation who will have access to the information)"]
[null,"Will the information be provided to any other parties?","(Please select...)"]
[null,"Please provide details of who it will be on-provided to, and how","(Please provide further details)"]
[null,"Will the information be used (includes analysis):"]
[null,"In identifiable form","(Please select...)"]
[null,"Outside the WA health system","(Please select...)"]
[null,"Outside state of WA","(Please select...)"]
[null,"For commercial purposes","(Please select...)"]
[null,"Will the information be disclosed:"]
[null,"In identifiable form","(Please select...)"]
[null,"Outside the WA health system","(Please select...)"]
[null,"Outside state of WA","(Please select...)"]
[null,"For commercial purposes","(Please select...)"]
[null,"Will the information be stored:"]
[null,"In identifiable form","(Please select...)"]
[null,"Outside the WA health system","(Please select...)"]
[null,"Outside state of WA","(Please select...)"]
[null,"What are the intended outputs from this information?"]
[null,"Output Type 1","(Please select...)"]
[null,"Output 1 Details","(Please provide further details)"]
[null,"Output Type 2","(Please select...)"]
[null,"Output 2 Details","(Please provide further details)"]
[null,"Output Type 3","(Please select...)"]
[null,"Output 3 Details","(Please provide further details)"]
[null,"Will the information be published / made public?","(Please select...)"]
[null,"Please provide details of where and how it will be published/made public","(Please provide further details)"]
[null,"Identifiability of results","(Please select...)"]
[null,"Other request details","(Please include any other information regarding the request for information)"]
[]
[null,"Security Plan"]
[null,"Where and how will the information be stored?","(Please provide details)"]
[null,"What physical security arrangements will be in place?","(Please provide details)"]
[null,"What technological security arrangements will be in place? ","(Please provide details)"]
[null,"Will the information be transported?","(Please select...)"]
[null,"How will informtion be secured during transport?","(Please provide details)"]
[null,"How long will the information be retained for?","(Please select...)"]
[null,"How will information be destroyed/disposed of?","(Please provide details)"]
[null,"Other security plan details","(Please provide details)"]
[]
[null,"Other Information"]
[null,"Additional project information","(Please include any other information relevant to this request for information)"]

{"sheet":"Requestor_Options","index":1,"n_rows":145,"n_cols":4,"rows_kept":145,"cut":false,"hidden":true,"merged":[]}
["Requestor Information"]
["Institution / Organisation","(Please select…)"]
[null,"WA Department of Health"]
[null,"North Metropolitan Health Service"]
[null,"South Metropolitan Health Service"]
[null,"East Metropolitan Health Service"]
[null,"Child & Adolescent Health Service"]
[null,"WA Country Health Service"]
[null,"Health Support Services"]
[null,"PathWest"]
[null,"Other Institution",null,"Data will be disclosed outside WA Health"]
[null,null,null,"Data will be disclosed interstate/overseas"]
["Outside WA","(Please select…)",null,"Data will be disclosed outside WA Health AND interstate/overseas"]
[null,"ACT"]
[null,"NSW","Outside WA",{"$f":"IF(RequestorInstLocation=\"(Please select...)\",0,1)","v":0}]
[null,"QLD"]
[null,"VIC"]
[null,"SA"]
[null,"NT"]
[null,"Overseas"]
[]
["Data Request "]
["Level of information","(Please select…)","Participant Consent","(Please select…)"]
[null,"Unit (row), record or event level data (Most granular data)",null,"Informed consent has been or will be obtained for each participating individual "]
[null,"Aggregated or tabulated data (Summarised data)",null,"Informed consent will not be obtained"]
[null,null,null,"A 'Waiver of Consent' has been or will be sought"]
["Identification","(Please select…)"]
[null,"Identifiable - includes participant identifiers (e.g. patient ID, UMRN, names)"]
[null,"De-identified - includes dummy/masked participant identifiers"]
[null,"Un-identified - does not include any participant identifiers"]
[]
[null,null,"ResearchApprovals","Information not for research"]
[null,null,null,"Research: HREC & RGS approval obtained"]
[null,null,null,"Research: HREC approval obtained, no RGS approval"]
[null,null,null,"Research: no HREC approval, RGS approval obtained"]
["ResearchHREC","(Please select…)",null,"Research: no approvals obtained (HREC or RGS)"]
[null,"HREC approval has been obtained",null,"Clarify request purpose"]
[null,"HREC approval has not been obtained"]
[]
["ResearchRGS","(Please select…)"]
[null,"RGS approval has been obtained"]
[null,"RGS approval has not been obtained"]
[]
["Onprovided","(Please select…)"]
[null,"Yes, information will be on-provided"]
[null,"No, information will not be on-provided"]
[]
["Outputs","(Please select…)"]
[null,"Report"]
[null,"Briefing note",null,"Check that the information is required for research purposes"]
[null,"Ministerial",null,"Research article intended, research approvals OK"]
[null,"Research article / journal paper",null,"Research article intended, research approvals still outstanding"]
[null,"Presentation"]
[null,"Media release",null,"Refer to Media Communication Policy & Information Disclosure Model"]
[null,"Parliamentary question",null,"Check whether PQ should be redirected to this Custodian"]
[null,"Grant application"]
[null,"Other"]
[]
["Published","(Please select…)"]
[null,"Yes - Information or outputs will be published / made public"]
[null,"No - Information or outputs will not be published / made public"]
[]
["Transport","(Please select…)"]
[null,"Yes - Information will be transported"]
[null,"No - Information will not be transported"]
[]
["Frequency","(Please select…)"]
[null,"Once-off"]
[null,"Weekly"]
[null,"Monthly"]
[null,"Quarterly"]
[null,"Annually"]
[null,"Other"]
[]
["Reident risk","(Please select…)"]
[null,"Results will be published/made public in non-identifiable form"]
[null,"Results will be published/made public in de-identified form"]
[null,"Results will be published/made public in re-identifiable form"]
[null,"Results will be published/made public in identifiable form"]
[]
["Use Details"]
["Use_Ident_form","(Please select…)"]
[null,"Yes - Information will be used and/or analysed in an identifiable form"]
[null,"No - Information will not be used and/or analysed in an identifiable form"]
[]
["Use_OutsideWAHealth","(Please select…)"]
[null,"Yes - Information will be used outside the WA health system"]
[null,"No - Information will not be used outside the WA health system"]
[]
["Use_ExternalToWA","(Please select…)"]
[null,"Yes - Information will be used within Australia, external to WA"]
[null,"Yes - Information will be used internationally, external to Australia"]
[null,"No - Information will not be used outside of WA"]
[]
["Use_commercial","(Please select…)"]
[null,"Yes - Information will be used for commercial purposes"]
[null,"No - Information will not be used for commercial purposes"]
[]
["Disclosure Details"]
["Disclosure_Ident_form","(Please select…)"]
[null,"Yes - Information will be disclosed in an identifiable or re-identiable form"]
[null,"No - Information will not be disclosed in an identifiable or re-identifiable form"]
[]
["Disclosure_OutsideWAHealth","(Please select…)"]
[null,"Yes - Information will be disclosed outside the WA health system"]
[null,"No - Information will not be disclosed outside the WA health system"]
[]
["Disclosure_ExternalToWA","(Please select…)"]
[null,"Yes - Information will be disclosed within Australia, external to WA"]
[null,"Yes - Information will be disclosed internationally, external to Australia"]
[null,"No - Information will not be disclosed outside of WA"]
[]
["Disclosure_commercial","(Please select…)"]
[null,"Yes - Information will be disclosed for commercial purposes"]
[null,"No - Information will not be disclosed for commercial purposes"]
[]
["Storage Details"]
["Storage_Ident_form","(Please select…)"]
[null,"Yes - Information will be stored in an identifiable form"]
[null,"No - Information will not be stored in an identifiable form"]
[]
["Storage_OutsideWAHealth","(Please select…)"]
[null,"Yes - Information will be stored outside the WA health system"]
[null,"No - Information will not be stored outside the WA health system"]
[]
["Storage_ExternalToWA","(Please select…)"]
[null,"Yes - Information will be stored within Australia, external to WA"]
[null,"Yes - Information will be stored internationally, external to Australia"]
[null,"No - Information will not be stored outside of WA"]
[]
["Disclosure_Purpose","(Please select...)"]
[null,"For patient treatment, care or wellbeing"]
[null,"For research"]
[null,"For the media"]
[null,"For disclosure under the Freedom of Information Act 1992"]
[null,"For planning, provision, monitoring and evaluation of public health services and purposes under s220(1)(a) of the HS Act"]
[null,"For other purposes"]
[]
["Retention_Period","(Please select...)"]
[null,"Less than 3 years post completion"]
[null,"Less than 5 years post completion"]
[null,"Less than 7 years post completion"]
[null,"Less than 10 years post completion"]
[null,"Greater than 10 years post completion"]
[null,"Information will be retained indefinitely"]

{"sheet":"CUSTODIAN","index":2,"n_rows":115,"n_cols":4,"rows_kept":115,"cut":false,"hidden":true,"merged":[[2,1,2,2],[3,1,3,2],[52,1,52,2],[65,1,65,2]]}
[]
[]
[null,"Information Use and Disclosure Checklist"]
[null,"Please refer to the Information Use & Disclosure Policy as part of the Information Management Policy Framework for information on the use and disclosure of information from the WA Department of Health and Health Service Providers.\n\nThis checklist is to be used in conjunction with the Policy, and is intended as a guide only. Custodians should be familiar with the Policy, and seek further legal or other advice as required. This is a dynamic form that will prompt for further information based upon responses provided. All sections need to be completed to guide a full and proper assessment of this request. \n\nYou must ensure that you have been delegated the relevant functions and powers to disclose information from the data collection in line with the Department CEO Instrument of Delegation, Health Information, Health Services Act 2016 before authorising the requested disclosure of information."]
[null,"I have confirmed that I have been delegated the relevant functions and powers to assess and authorise a disclosure in line with the requirements of the Health Services Act 2016 and relevant Regulations.","(Please select...)"]
[]
[null,"Part C: Information Disclosure"]
[null,"Request Overview","Cells highlighted yellow are pre-filled by the Requestor. Red gradient highlights concerns."]
[null,"Information identifiability",{"$f":"InformationIdentifiability","v":"(Please select...)"}]
[null,"Granularity of information",{"$f":"InformationFormat","v":"(Please select...)"}]
[null,"Research / non-research purposes & approvals",{"$f":"IF(AND(InformationForResearch=IsResearch,HRECApproval=ObtainedHREC,GovernanceApproval=ObtainedRGS),HRECApprovedRGSApproved,\nIF(AND(InformationForResearch=IsResearch,HRECApproval=ObtainedHREC,GovernanceApproval=NotRGS),HRECApprovedRGSNot,\nIF(AND(InformationForResearch=IsResearch,HRECApproval=NoHREC),HRECNotRGSNot,\nIF(AND(InformationForResearch=IsFOI),\"Refer requestor to FOI Officer\",\nIF(AND(InformationForResearch=IsOtherPurpose),ClarifyRequestPurpose,\nIF(AND(InformationForResearch=\"(Please Select...)\"),\"N/A\", NotForResearch))))))","v":"N/A"}]
[null,"Information to be on-provided",{"$f":"OnProvided","v":"(Please select...)"}]
[null,"Details of on-provision",{"$f":"IF(OnProvided=YesOnProvided, WhoOnProvided, \"N/A\")","v":"N/A"}]
[null,"Details of data retention",{"$f":"InformationRetained","v":"(Please select...)"}]
[null,"Information to be used/analysed:"]
[null,"In identifiable form",{"$f":"UsedInIdentForm","v":"(Please select...)"}]
[null,"Outside the WA Health System",{"$f":"UsedOutsideWAHS","v":"(Please select...)"}]
[null,"Outside WA",{"$f":"UsedOutsideWA","v":"(Please select...)"}]
[null,"For commercial purposes",{"$f":"UsedForCommercial","v":"(Please select...)"}]
[null,"Information to be disclosed:"]
[null,"In identifiable form",{"$f":"DisclosedInIdentForm","v":"(Please select...)"}]
[null,"Outside the WA Health System",{"$f":"DisclosedOutsideWAHS","v":"(Please select...)"}]
[null,"Outside WA",{"$f":"DisclosedOutsideWA","v":"(Please select...)"}]
[null,"For commercial purposes",{"$f":"DisclosedForCommercial","v":"(Please select...)"}]
[null,"Information to be published / made public?",{"$f":"IF(PublishedPublic=YesPublishedPublic, IF(PublishedPublicDetails=\"(Please provide details)\", YesPublishedPublic & \". \" & \"Requestor did not provide extra detail\",YesPublishedPublic & \". \" &PublishedPublicDetails), NotPublishedPublic)","v":"No - Information or outputs will not be published / made public"}]
[null,"Identifiability of results",{"$f":"IF(OR(DisclosedInIdentForm=YesDisclosedInIdentForm, ResultsIdent=Reident_IdentForm), \"Results will be disclosed/published or made available in an identifiable form\",\n(IF(ResultsIdent=Reident_ReidentForm, Reident_ReidentForm,\n(IF(ResultsIdent=Reident_DeidentForm,Reident_DeidentForm,\n(IF(ResultsIdent=Reident_NonidentForm,Reident_NonidentForm,\n\"N/A\")))))))","v":"N/A"}]
[null,"Intended outputs"]
[null,"Output 1",{"$f":"Output1","v":"(Please select...)"}]
[null,"  Output 1 considerations",{"$f":"IF(AND(Output1=Outputs_Research, InformationForResearch<>IsResearch), OutputAdvice_CheckResearch,\nIF(AND(Output1=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSApproved), OutputAdvice_CheckApprovals,\nIF(OR(AND(Output1=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSNot), AND(Output1=Outputs_Research, PartC_PurposeApprovals=HRECNotRGSApproved), AND(Output1=Outputs_Research, PartC_PurposeApprovals=HRECNotRGSNot)), OutputAdvice_ApprovalsPending,\nIF(Output1=Outputs_MediaRelease, OutputAdvice_CheckMedia,\nIF(Output1=Outputs_ParlimentaryQuestion, OutputAdvice_CheckPQ,\n\"N/A\")))))","v":"N/A"}]
[null,"Output 2",{"$f":"Output2","v":"(Please select...)"}]
[null,"  Output 2 considerations",{"$f":"IF(AND(Output2=Outputs_Research, InformationForResearch<>IsResearch), OutputAdvice_CheckResearch,\nIF(AND(Output2=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSApproved), OutputAdvice_CheckApprovals,\nIF(OR(AND(Output2=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSNot), AND(Output2=Outputs_Research, PartC_PurposeApprovals=HRECNotRGSApproved)), OutputAdvice_ApprovalsPending,\nIF(Output2=Outputs_MediaRelease, OutputAdvice_CheckMedia,\nIF(Output2=Outputs_ParlimentaryQuestion, OutputAdvice_CheckPQ,\n\"N/A\")))))","v":"N/A"}]
[null,"Output 3",{"$f":"Output3","v":"(Please select...)"}]
[null,"  Output 3 considerations",{"$f":"IF(AND(Output3=Outputs_Research, InformationForResearch<>IsResearch), OutputAdvice_CheckResearch,\nIF(AND(Output3=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSApproved), OutputAdvice_CheckApprovals,\nIF(OR(AND(Output3=Outputs_Research, PartC_PurposeApprovals=HRECApprovedRGSNot), AND(Output3=Outputs_Research, PartC_PurposeApprovals=HRECNotRGSApproved)), OutputAdvice_ApprovalsPending,\nIF(Output3=Outputs_MediaRelease, OutputAdvice_CheckMedia,\nIF(Output3=Outputs_ParlimentaryQuestion, OutputAdvice_CheckPQ,\n\"N/A\")))))","v":"N/A"}]
[null,"Data to be transported",{"$f":"InformationTransported& \". \" &HowTransported","v":"(Please select...). (Please provide details)"}]
[]
[null,"Application of Information Use & Disclosure Policy and Principles. Custodian/Steward to complete below fields"]
[null,"1. As the Custodian, I am satisfied that the security plan is satisfactory","(Please select...)"]
[null,null,"Please continue to Question 2a"]
[null,null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,null,"Please seek further information from Requestor"]
[null,"2. Authority to Disclose"]
[null,"2a. What is the purpose of the disclosure?","(Please select...)"]
[null,null,"Refer to local policies"]
[null,null,"Refer to Research Policy Framework"]
[null,null,"Refer to Media Communication Policy"]
[null,null,"Refer to 'FOI Reporting within the Public Health System' Policy"]
[null,null,"Refer to relevant legislation or policy"]
[null,null,"Refer to Information Disclosure Model"]
[null,"2b. Am I authorised to disclose the information for the stated purpose?","(Please select...)"]
[null,null,"Please continue to Question 3a"]
[null,null,"DO NOT DISCLOSE THE INFORMATION - escalate to Steward"]
[null,null,"Refer to Section 3.4 of the Policy"]
[null,"3. Where personal information is requested, as the Custodian, I am satisfied that the disclosure complies with Regulation 3 of the Health Services (Information) Regulations 2017, in that:"]
[null,"3a. The disclosure of the requested information is reasonably necessary for the stated purpose","(Please select...)"]
[null,null,"Please continue to Question 3b"]
[null,null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,null,"Please seek further information from Requestor"]
[null,"3b. The purpose cannot be achieved without the disclosure of information that is not personal information","(Please select...)"]
[null,null,"Please continue to Question 3c"]
[null,null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,null,"Please seek further information from Requestor"]
[null,"3c. It is impracticable to obtain consent of the individual to whom the information relates","(Please select...)"]
[null,null,"Please continue to Question 4a"]
[null,null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,null,"Please seek further information from Requestor"]
[null,"Please note: 'Impracticable' means that consent is unavailable because of practical obstacles to obtaining it. 'Impracticable' does not mean difficult or undesirable. The fact that seeking consent is inconvenient or would involve expenditure of some effort or resources is not sufficient."]
[null,"4. Lawful Disclosure"]
[null,"4a. Is this disclosure lawful","(Please select...)"]
[null,null,"Please continue to Question 4b"]
[null,null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,null,"Please seek further information from Requestor"]
[null,"4b. Basis upon which disclosure is lawful","(Please select...)"]
[null,null,"Disclose information in accordance with relevant legal requirements"]
[null,null,"Seek legal advice before making a public interest disclosure"]
[null,null,"Please continue to Question 5a"]
[null,null,"Please continue to Question 5c"]
[null,"5. Information & Disclosure Policy Principles"]
[null,"5a. Is the information personal or non-personal","(Please select...)"]
[null,null,"Please continue to Question 5b"]
[null,null,"Please continue to Question 5c"]
[null,"5b. Is the information sensitive","(Please select...)"]
[null,null,"Please continue to Question 5c"]
[null,"5c. Apply the relevant policy principles. Non-relevant principles have been concealed based upon above responses."]
[null,"P1: Does the use and disclosure of information comply with relevant system-wide and local policies?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoNotSensitive), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoSensitive)), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P2: Is the information to only be used and disclosed for the specified authorised purpose?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoNotSensitive), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoSensitive), Q4B=DisclosureWithConsent), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P3: Will the information be protected by appropriate and approved security measures?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoNotSensitive), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoSensitive), Q4B=DisclosureWithConsent), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P4: Has the recipient ensured that the information will not be re-identified?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoNotSensitive), AND(Q4B=DisclosureAuthorised, Q5A=InfoNonPersonal, Q5B=InfoSensitive), Q4B=DisclosureWithConsent), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P5: Is the use or disclosure of personal information reasonably necessary for the activity, and the activity cannot be served using non-personal information?","(Please select...)",{"$f":"IF(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P6: Is it impracticable to seek the person's consent to use or disclose their personal information?","(Please select...)",{"$f":"IF(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P7: Is the use and disclosure of personal information on a need-to-know basis?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised,Q5A=InfoNonPersonal,Q5B=InfoSensitive),AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal)),PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P8: Is only the minimum amount of personal information being used or disclosed to accomplish the specified purpose?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised,Q5A=InfoNonPersonal,Q5B=InfoSensitive),AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal)), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,"P9: Has the recipient confirmed that personal information will not be published in a generally available publication?","(Please select...)",{"$f":"IF(OR(AND(Q4B=DisclosureAuthorised, Q5A=InfoPersonal), Q4B=DisclosureWithConsent), PPRelevance_ApplyPrinciple, PPRelevance_NotRelevant)","v":"Not relevant"}]
[null,null,{"$f":"IF(CountApplyPrinciple=0, \"N/A\", IF(CountApplyPrinciple=CountYes, DisclosureOutcome_Ok, IF(CountNo<>0, DisclosureOutcome_NotCompliant, DisclosureOutcome_Check)))","v":"N/A"}]
[null,"Part D: Disclosure Outcome"]
[null,"Calculated assessment of Data Custodian responses"]
[null,"Can this information be disclosed "]
[null,"Refer to the following for more information for this type of disclosure"]
[null,"Does the Data Steward need to be consulted"]
[null,"Do you wish to escalate this request to the Data Steward for consideration"]
[]
[null,"Part E: Data Custodian Authorisation"]
[null,"Data Custodian Details"]
[null,"Name"]
[null,"Position"]
[null,"Signature"]
[null,"Dated"]
[null,"Notes"]
[]
[null,"Part F: Data Steward Authorisation"]
[null,"Data Steward Details"]
[null,"Name"]
[null,"Position"]
[null,"Signature"]
[null,"Dated"]
[null,"Notes"]

{"sheet":"Custodian_Options","index":3,"n_rows":94,"n_cols":5,"rows_kept":94,"cut":false,"hidden":true,"merged":[[57,0,57,3]]}
["Information Disclosure"]
["DisclosurePurpose","(Please select...)"]
[null,"For patient treatment, care or wellbeing",null,"Refer to Health Service Provider local policies"]
[null,"For research",null,"Refer to Research Policy Framework & Information Disclosure Model","http://www.health.wa.gov.au/circularsnew/Research.cfm"]
[null,"For the media",null,"Refer to Media Communication Policy & Information Disclosure Model","http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=12369"]
[null,"For disclosure under the Freedom of Information Act 1992",null,"Refer to 'FOI Reporting within the Public Health System' Policy & Information Disclosure Model","http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=12383"]
[null,"For planning, provision, monitoring and evaluation of public health services and purposes under s220(1)(a) of the HS Act",null,"Refer to Information Disclosure Model","https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/WA_Health/DOHSM.IM.MP.0015.16.InformationUseandDisclosurePolicyAtt1InformationDisclosureModel.pdf"]
[null,"For other purposes",null,"Refer to relevant legislation or policy & Information Disclosure Model"]
[]
["DisclosureAuthorised","(Please select…)","DisclosureAuthorisedAction","(Please select...)"]
[null,"Yes",null,"Please continue to Question 4a"]
[null,"No",null,"DO NOT DISCLOSE THE INFORMATION - escalate to Steward"]
[null,"Unsure",null,"Refer to Section 3.4 of the Policy","https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/WA_Health/DOHSM.IM.MP.0015.16.InformationUseandDisclosurePolicy.pdf"]
[]
["DisclosureLawful","(Please select…)","DisclosureLawfulAction","(Please select...)"]
[null,"Yes",null,"Please continue to Question 4b"]
[null,"No",null,"DO NOT DISCLOSE THE INFORMATION"]
[null,"Unsure",null,"Seek legal advice before proceeding"]
[]
["DisclosureLawfulType","(Please select…)"]
[null,"Disclosure is authorised by law",null,"Disclose information in accordance with relevant legal requirements"]
[null,"Information is being disclosed with consent",null,"Seek legal advice before making a public interest disclosure"]
[null,"Disclosure is required by law",null,"Please continue to Question 5a"]
[null,"Disclosure is in the public interest",null,"Please continue to Question 5c"]
[]
["Type of information","(Please select…)"]
[null,"Personal",null,"Please continue to Question 5c"]
[null,"Non-Personal",null,"Please continue to Question 5b"]
[]
["Sensitivity","(Please select…)",null,"Please continue to Question 5c"]
[null,"Yes - the information requested is sensitive"]
[null,"No - the information request is not sensitive"]
[]
["Policy Principles","1. Use and disclosure of information must comply with relevant system-wide and local policies"]
[null,"2. Information must only be used and disclosed for authorised purposes","Count Apply Principle",{"$f":"COUNTIF(Q5C1:Q5C9,PPRelevance_ApplyPrinciple)","v":0}]
[null,"3. Information must be protected by appropriate and approved security measures","Count Yes",{"$f":"COUNTIF(Q5CPP1:Q5CPP9,\"Yes\")","v":0}]
[null,"4. The receipient of non-personal information must ensure that information is not re-identified","Count No",{"$f":"COUNTIF(Q5CPP1:Q5CPP9,\"No\")","v":0}]
[null,"5. Use of disclosure of personal information is reasonably necessary for the activity and the activity cannot be served using non-personal information"]
[null,"6. It is impracticable to seek the person's consent to use or disclose their personal information"]
[null,"7. The use and disclosure of personal information must occur on a need-to-know basis"]
[null,"8. The minimum amount of personal information should be used or disclosed to accomplish the purpose"]
[null,"9. Personal information must not be published in a generally available publication"]
[]
[null,"1. Use and disclosure of information must comply with relevant system-wide and local policies\n2. Information must only be used and disclosed for authorised purposes\n3. Information must be protected by appropriate and approved security measures"]
[]
["PPRelevance","Apply Principle"]
[null,"Not relevant"]
[]
["PPResponse","(Please select…)"]
[null,"Yes"]
[null,"No"]
[null,"Unsure"]
[]
["PPOutcome","OK - all relevant policy principles met"]
[null,"Check all relevant policy principles are met before proceeding"]
[null,"Not compliant with all relevant policy principles"]
[]
["Part C: Information Disclosure"]
[]
["PurposeOK","(Please select...)"]
[null,"Yes - I am satisfied the request for information is appropriate",null,"Please continue to the next question"]
[null,"No - I do not believe the request for information is appropriate",null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,"Unsure",null,"Please seek further information from Requestor"]
[]
[null,"(Please select...)"]
[null,"Yes - I am satisfied the disclosure is necessary",null,"Please continue to Question 1b"]
[null,"No - I do not believe that the disclosure is necessary",null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,"Unsure",null,"Please seek further information from Requestor"]
[]
[null,"(Please select...)"]
[null,"Yes - I am satisfied that personal information is required",null,"Please continue to Question 1c"]
[null,"No - I do not believe that personal information is required",null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,"Unsure",null,"Please seek further information from Requestor"]
[null,"Not applicable",null,"N/A"]
[]
[null,"(Please select...)"]
[null,"Yes - I am satisfied that consent cannot be obtained",null,"Please continue to Question 2"]
[null,"No - I believe that consent can be obtained",null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,"Unsure",null,"Please seek further information from Requestor"]
[]
[]
[]
["SecurityOK","(Please select...)"]
[null,"Yes - I am satisfied with the security plan for this request",null,"Please continue to Question 3"]
[null,"No - I am not satisified with the security plan for this request",null,"DO NOT DISCLOSE THE INFORMATION until outstanding issues are resolved"]
[null,"Unsure",null,"Please seek further information from Requestor"]
[]
["Outcome","YES - information may be disclosed"]
[null,"PENDING - please check items highlighted above before disclosing the information"]
[null,"NO - Information can not be disclosed; please see items highlighted above in red"]
[]
[]
["Steward","Yes - The Data Steward needs to be consulted; the Requestor indicated that information is to be disclosed overseas and/or for commercial use or you had indicated that you were not authorised to disclose the information."]
[null,"No - The Data Steward does not need to be consulted, unless the Data Custodian wishes to do so."]