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INTERAGENCY DATA SHARING AGREEMENT
Oshkosh Area Emergency Services Collaboration- Fall Prevention
Purpose: All parties involved in this agreement have the authority and responsibility to
protect the health and safety of individuals and to provide services that improve the well-
being of individuals and their families.
The City of Oshkosh Fire Department (OFD) and Emergency Medical Service (EMS) and
Winnebago County Public Health (WCPH) will exchange patient and client information
among the population who request EMS services for falls.
This exchange of information will assist in the unified goal among the agencies to connect
people who use emergency services to the proper long-term support services available to
them, to improve health, and reduce the burden on EMS and healthcare systems.
The data will only be used for outreach, program planning, implementation, administration,
research, and analytical purposes. The parties agree to the provisions specified in this
Agreement and, as applicable, the Health Insurance Portability and Accountability Act
(HIPAA), and all other public health, personal health services, research, and confidentiality
laws.
Period of Agreement
The period of agreement shall extend from December 1, 2025 to October 31st, 2028.
Justification for Access
HIPAA General Public Health Activities: The Privacy Rule permits covered entities to
disclose protected health information, without authorization, to public health authorities
who are legally authorized to receive such reports for the purpose of preventing or
controlling disease, injury, or disability.
A “public health authority” is an agency or authority of the United States government, a
State, a territory, a political subdivision of a State or territory, or Indian tribe that is
responsible for public health matters as part of its official mandate, as well as a person or
entity acting under a grant of authority from, or under a contract with, a public health
agency.
Docusign Envelope ID: 3DAB2927-81CB-4ACE-AE17-8A05235F4EA0
For disclosures to a public health authority, covered entities may reasonably rely on a
minimum necessary determination made by the public health authority in requesting the
protected health information. See 45 CFR 164.514(d)(3)(iii)(A). For routine and recurring
public health disclosures, covered entities may develop standard protocols, as part of their
minimum necessary policies and procedures, that address the types and amount of
protected health information that may be disclosed for such purposes. See 45 CFR
164.514(d)(3)(i). Source: https://www.hhs.gov/hipaa/for-professionals/special-topics/public-health/index.html
Data Disclosed under this Agreement
Data that is shared and exchanged includes the following;
• Name and contact information of person(s) who use emergency services and of
necessary family contacts and/or emergency contacts, landlord or housing
contact
• Referral(s)
• Care plans
• Organizations or individuals associated with care plans
• Specific case data and/or aggregate data to determine and support prevention
strategies
Confidentiality
The data users will:
Limit access to these data only to those employees whose job responsibilities require
access to the information
Use appropriate safeguards to prevent the use or disclosure of the information other than
as provided by this Agreement
Not use the data provided to engage in any method, act, or practice which constitutes a
commercial solicitation or advertisement of goods, services, or real estate to consumers.
Disposition of Data
The requestor and its agents will destroy all confidential information associated with actual
records as soon as the purposes of the project have been accomplished and notify the
providing agency to this effect in writing. Once the project is complete, the requester will:
• Destroy all hard copies containing confidential data (e.g., shredding or burning);
• Archive and store electronic data containing confidential information offline in a
secure place, and delete all online confidential data; and
Docusign Envelope ID: 3DAB2927-81CB-4ACE-AE17-8A05235F4EA0
• All other data will be erased or maintained in a secured area.
This Agreement may be amended in a writing that is signed by each party’s authorized
representative. The parties acknowledge and agree that the unauthorized use or disclosure
of confidential information is punishable by imprisonment or fine or both under applicable
state and federal laws specific to the data released.
The parties have read and understand the above conditions and acknowledge that by their
authorized representative’s signature below they agree to the terms and conditions above.
Each party acknowledges that its authorized representative has the authority to execute
this agreement its behalf.
City of Oshkosh Fire Department and EMS
Signature: ___________________________________________________ Date: ____________
Print Name: Tim Heiman
Title: Fire Chief
Signature: ___________________________________________________ Date: ____________
Print Name: Aaron Droessler
Title: Division Chief of EMS
Winnebago County Public Health
Signature: _____________________________________________ Date: 12/9/25___
Print Name: Doug Gieryn
Title: Health Officer
Docusign Envelope ID: 3DAB2927-81CB-4ACE-AE17-8A05235F4EA0
12/9/2025
12/10/2025