Case Mix Application Documents

Case Mix Fee Schedule Update

• Administrative Bulletin 17-05 - Hospital Case Mix and Charge Data Fee Schedule (PDF) | Word
  (Effective January 1, 2018)

Data Use Agreement for All Protect Health Information (PHI)

• Data Use Agreement (PDF) | Word
• Please watch a short video, Data Use Obligations of Recipients of CHIA Data, intended for researchers holding and using CHIA confidential data.

Data Management Plan for Use of CHIA Data

• Data Management Plan (PDF) | Word

Application Materials for Government Entities Requesting Case Mix Data: 

• Case Mix Application Form – Government Entities (PDF) | Word

Application Materials for Non-Government Entities Requesting Case Mix Data:

• Fee Remittance or Fee Waiver Request Form (PDF) | Word
• Case Mix Request Form: Non-Government (PDF) | Word
• Non-Governmental Application for Re-Use Case Mix Data (PDF) | Word

Summary of Changes to Data Release 2017

• Revisions to Data Release Procedures (PDF) | Word

Note: APCD application documents are located here.