Sample letter to send to your state Department of Health

Use the following sample letter to send to your state Department of Health. Government data practices laws and rules allow citizens to request and receive data on themselves and their children from the government.

Date_______________

Commissioner ________________
_______________ Department of Health
Address
City, State, Zip

Dear Commissioner _________________,

I am making a data practices request under the authority of the __________________Government Data Practices Act. I am requesting a comprehensive accounting of the data and blood spots of my child that were collected through the State newborn screening program. Specifically, I am requesting a comprehensive accounting of the collection, storage, use and dissemination of my child's newborn blood spots, my child's newborn screening laboratory test results, and any information (including parent information) associated with my child's newborn blood spots and my child's newborn screening test results.

Such accounting must include, but is not limited to, internal uses by the _____________________ Department of Health, all Department contracts and/or data sharing agreements which include the sharing and/or use of my child's blood spots and data with government or outside entities, all internal and/or external research, public health studies, newborn studies, other studies, other testing, test development using my child's blood spots and/or data, all linkages to my child's data and blood spots within and outside the State Department of Health, storage of the data and/or blood spots in databases or repositories in and outside the State Department of Health, all research findings in which my child's data or blood spots were stored, used, and/or disseminated, and any other collection, storage, use and/or dissemination of my child's data or blood spots.

My child's complete name is ___________
My child's birth data is __________
My child was born at _____________ (institution)
The mother's name at the time of the birth was _____________

Thank you for your assistance with my request. Please let me know when I can expect to receive this information.

Sincerely,

Parent Name (Print Full Name)_____________________________________________

Address________________________________________________________________

City, State, Zip___________________________________________________________

Phone Number__________________________________________

Email Address_______________________________________________________

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