Application Forms

Materials on this page are available for download. Please acknowledge the WA Department of Health or Data Linkage Services as a source where applicable.

Application for Data

An Application for Data has 3 different modules. Please complete the modules relevant to your application and submit according to the relevant submission instructions at Application Process.

Please note that the forms used for the draft application are the same as for the final application.

Complete the checklist below when submitting the draft application:
Draft Application Checklist (Word Doc, 155KB)

Module 1: Application for Data Form and Data Management Plan

Application for Data Form (Word Doc, 450KB)

Data Management Plan (Word Doc, 198KB)

Module 2: Data Services

To properly understand your request, we require you to submit one or more of the following forms:

(Word Doc, 266KB)
If you are interested in linking external data (e.g. results of a survey) to the Department of Health WA datasets
(Word Doc, 279KB)
If you are interested in obtaining and extract of data from the Department of Health WA datasets.
(Word Doc, 243KB)
If you wish to give Data Linkage a list of addresses to be geocoded.
NOTE: You don’t need to submit this form if you require SEIFA/ARIA codes on a data extract
Electoral Roll Sample Selection
(Word Doc, 117KB)
If you require an identifiable sample from the WA Electoral Roll for mailout purposes.
Family Connections
(Word Doc, 277KB
If you require genealogical relationships.
Matched Comparison Group Selection
(Word Doc, 280KB)
If you require comparison or control populations for study cohorts to facilitate case-control studies. The Control Selection Guide may help you as well.
Identifiable Data 3rd Party Linkage
(Word Doc, 261KB)
If you require an extraction of identifiable data to be sent to a third party linkage agency.
Aboriginal and/or Torres Strait Islander Flag
(Word Doc, 238KB)
If you require the use of a validated algorithm to generate an Aboriginal and/or Torres Strait Islander Status flag.

Module 3: Variable Lists

Please complete the variable list for each dataset you require. For variable lists that are not listed here please contact

Core Datasets
Other Datasets

Application for Amendment

Please ensure that you have been in contact with ISPD Client Services ( and Department of Health Human Research Ethics Committee for advice, prior to any amendment requests and the submission of the form below.

Application for Ethical Review (Department of Health Human Research Ethics Committee)

WA Health Ethics forms and other ethics documentation (e.g., amendments, confidentiality declarations) are submitted via the WA Health Research Governance System. Please see the Department of Health Human Research Ethics Committee website for more information.

Draft Output Review

All outputs resulting from the analysis of Department of Health data must be submitted for Data Custodian review. To submit a draft output for review, please complete the checklist below and email it, with the draft output to

Please allow up to two full working weeks for feedback or possibly longer if the output is very long (e.g., a student thesis).