Document EvJ6JoYG00rnOVN8K65kymkkj

PERMISSION TO RELEASE DEATH CERTIFICATES FOR AN EPIDEMIOLOGY STUDY The State of Oregon This document is intended to grant permission to ENSR Health Sciences, Alameda, California, to release death certificates (and data 'derived from them) for subjects belonging to the industry-wide vinyl chloride workers study described in the March 1, 1995 letter from Dr. Hasmukh Shah of the Chemical Manufacturers Association and co-signed by Dr. Christian Seigneur of ENSR Health Sciences. It is understood tb,at ENSR Health Sciences will release such death .certificates (and data derived from them) ONLY to a representative of Applied ^Epidemiology Incorporated, of Amherst, Massachusetts, who has signed the enclosed letter to maintain the confidentiality of O' the death certificates and data derived from them. 7. Joi. d title of person authorized to grant this permission Signature ofpenon authorized to grant this permission /W3. Date CMA 120832 Department of Health HARRISBURG (717) 783-2548 July 6, 1995 Hasmukh C. Shah, Ph.D., D.A.B.T. Director, Vinyl Chloride Panel Chemical Manufacturers Association 2501 M Street, N.W. Washington, DC 20037 Dear Dr. Shah: RE: Application Number: 1C-1748 Study/Project Title: Update of the Epidemiologic Mortality Study of Vinyl Chloride Workers Thank you for forwarding a completed application detailing the activities of your mortality study as referenced above. With the updated information you have provided in your application, along with the assurances from all parties involved concerning confidentiality of information, I am able to authorize the transfer of Pennsylvania death records currently housed at ENSR Health Services to your new contractor, Applied Epidemiology Inc. Enclosed is a signed page authorizing the transfer of these records and any information derived from them, as you requested. If you require additional death records to update the current cohort for this specific study, please submit your list of study subjects along with the above referenced application number to Mr. Charles Hardester, Director, Division of Vital Records, P.O. Box 1528, New Castle, PA 16103 for processing. You will receive noncertified copies of the requested certificates and an invoice in the appropriate amount directly from them. The current fee for noncertified copies is $2.00 per copy. Please do not send payment with your list of study subjects, as the Division of Vital Records prefers to invoice upon completion of your request. Thank you for contacting the Division of Health Statistics and Research. Please let us know if we can be of further assistance. Enclosure Director, Division of Health Statistics and Research P.O. BOX 90, HARRISBURG, PA 17100 CMA120833 PERMISSION TO RELEASE DEATH CERTIFICATES FOR AN EPIDEMIOLOGY STUDY The State of Pennsylvania This document is intended to grant permission to ENSR Health Sciences, Alameda, California, to release death certificates (and data derived from them) for subjects belonging to the industry-wide vinyl chloride workers study described in the March 1, 1995 letter from Dr. Hasmukh Shah of the Chemical Manufacturers Association and co-signed by Dr. Christian Seigneur of ENSR Health Sciences. It is understood that ENSR Health Sciences will release such death certificates (and data derived from them) ONLY to a representative t of Applied Epidemiology Incorporated, of Amherst, Massachusetts, who has signed the enclosed letter to maintain the confidentiality of the death certificates and data derived from them. Patricia W. Potrzebowski, Ph.D. Director, Division of Health Statistics & Research Pennsylvania Department of Health Name and title of person authorized to grant this permission Signature of person authorized to grant this permission July 7, 1995 Date CMA 120834