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.|
(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 DataServ@health.wa.gov.au.
- Birth Registrations (Excel, 711KB)
- Death Registrations (Excel, 723KB)
- Cause of Death Unit Record File (Excel, 707KB)
- Electoral Roll Records (Excel, 702KB) (note: this is not required for identifiable extracts for mailouts. Please complete the Electoral Roll Sample Selection form above).
- Emergency Department Records (Excel, 721KB)
- Hospital Morbidity Records (Excel, 733KB)
- Mental Health Records (Excel, 725KB)
- Midwives Notification System (Excel, 754KB)
- MH NOCC Data (Excel, 712KB) (part of Mental Health measures)
- WA Cancer Registrations (Excel, 705KB)
- Health and Wellbeing Surveillance System – Adult (HWSS) (Word Doc, 711KB)
- Health and Wellbeing Surveillance System – Child (HWSS) (Word Doc, 713KB)
- WA Notifiable Infectious Diseases Database (WANIDD) (Excel, 727KB)
- WA Register of Developmental Anomalies – Birth Defects (Excel, 711KB)
- WA Register of Developmental Anomalies – Cerebral Palsy (Excel, 709KB)
- Child Development Service (CDS). (Excel,733 kb)
Application for Amendment
Please ensure that you have been in contact with ISPD Client Services (DataServ@health.wa.gov.au) and Department of Health Human Research Ethics Committee for advice, prior to any amendment requests and the submission of the form below.
- Data Amendment Form (Word Doc, 274KB)
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 DataServ@health.wa.gov.au
Please allow up to two full working weeks for feedback or possibly longer if the output is very long (e.g., a student thesis).
- Draft Output Review Checklist (Word Doc, 260KB)