AMD RE EPIDEMIOLOGY SVCS WITH UOFA .PDF

SECTION I GENERAL PROVISIONS
2. DEFINITIONS. Capitalized terms used herein shall have the meanings set forth in this
Section.
A. Agreement means this document and all attachments and amendments hereto.
B. Authorized Persons means MCDPH contractors who have a need to know or
otherwise access Personally Identifying Information to enable them to perform its
mission in conformance with the requirements of this IGA and who are bound in
writing by confidentiality obligations sufficient to protect Personally Identifying
Information in accordance with the terms and conditions of this IGA and applicable
law.
C. Contractor means the person, firm or organization listed on the Cover Page of this
Agreement.
D. County means Maricopa County, Arizona.
E. Department means the Maricopa County Department of Public Health.
F. Funding Source means any federal, State, or private agency funding source, which
may impose conditions on the funding that will be passed on to the Contractor.
G. Public Health Data means health information organized and maintained by MCDPH
or received by MCDPH under applicable law, including, but not limited to, patient
names, mailing addresses and geocodes, dates of birth and death, gender, race,
ethnicity, discharge status, disease codes, procedures performed and other
information reported to MCDPH under applicable law. The elements of data shared
and specific restrictions of their use under this MOU are fully described in sections
2.2 (Scope) and 19 (Data Use and Ownership).
H. Personally Identifying Information means information provided to the contractor
by, or at the direction of, MCDPH that:
H.1. Identifies or can be used to identify an individual (including, without limitation,
names, signatures, addresses, telephone numbers, e-mail addresses and
other unique identifiers); or
H.2. Can be used to authenticate an individual (including, without limitation,
employee identification numbers, government-issued identification numbers,
passwords or PINs, financial account numbers, credit report information,
biometric or health data, answers to security questions and other personal
identifiers).
I. Protected Health Information (PHI) means individually identifiable health
information including demographic information, or health information with respect to
which there is a reasonable basis to believe the information can be used to identify
individuals, collected, maintained or stored in any form (electronic or non-electronic),
relating to the past, present, or future physical or mental health or condition of an
individual; the provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual. This excludes individually

identifiable health information in education records covered by the Family
Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g; records
described at 20 U.S.C. 1232g(a)(4)(B)(iv); and employment records held by a
covered entity in its role as employer.
J. Public Health Practice means programs, projects, practices, and interventions
designed solely to enhance the well-being of a specific subject population and which
have reasonable expectation of success; including surveillance, needs assessments,
program evaluation, disease investigation, policy development and health education.
K. Research means a systematic investigation, including research development, testing
and evaluation, designed to develop or contribute to generalizable knowledge.
Activities which meet this definition constitute research for purposes of this IGA,
whether or not they are conducted or supported under a program which is
considered research for other purposes. For example, some demonstration and
service programs may include research activities.
L. Security Breach means: (i) any act or omission that materially compromises either
the security, confidentiality or integrity of Personally Identifying Information or the
physical, technical, administrative or organizational safeguards put in place by
MCDPH or any Authorized Persons that relate to the protection of the security,
confidentiality or integrity of Personal Information, or (ii) receipt of a complaint in
relation to the privacy practices of MCDPH or any Authorized Persons or a breach or
alleged breach of this MOU relating to such privacy practices.

SECTION IlI WORK STATEMENT
1. PURPOSE
The University of Arizona's Mel and Enid Zuckerman College of Public Health (MEZCOPH)
Student Aid for Field Epidemiology Response (SAFER) is a team of students who will
provide response aid to Maricopa County Department of Public Health (MCDPH) during
large community events such as the Super Bowl, infectious disease outbreaks, and public
health emergencies. SAFER will provide public health and epidemiology students with
experiential learning opportunities and will enhance MCDPH preparedness for public health
emergencies and contribute to the safety of Maricopa County citizens. The SAFER students
function under the Maricopa County Office of Epidemiology (OE) and will be coordinated by
the Incident Command Center (ICC) as needed in coordination with the Maricopa County
Office of Preparedness and Response (OPR).
2. BACKGROUND
The University of Arizona's Mel and Enid Zuckerman College of Public Health (MEZCOPH)
Student Aid for Field Epidemiology Response (SAFER) Team's goals are to provide public
health and epidemiology students with experiential learning opportunities with Maricopa
County Department of Public Health. Benefits to SAFER team members include gaining
public health experience and conducting tasks relevant to the mission of MCDPH.
3. RESPONSIBILITIES OF THE CONTRACTOR
A. The Faculty Principal Investigator (Pl)/Director for the SAFER Team will be
responsible for the supervision, tracking, and maintenance of all activities to the
Intergovernmental Agreement (IGA).
B. Two staff persons and/or student positons, as needed by workload and determined
by the PI for the SAFER Team shall each work on activities pertaining to this
Agreement.
C. The University of Arizona shall have students available to MCDPH when requested
during the academic calendar. Students should be available to MCDPH within one
(1) business day from the date of the request. In the event students are not available,
the Faculty Director and/or Graduate Research Assistant(s) will respond.
D. The SAFER annual report will be available to MCDPH for evaluation at the end of
each calendar year. Document on a quarterly basis (inclusive of Campy and
Salmonella)
• Number (N) of cases received
• Number (N) of cases Interviewed
• Number (N) of attempts to contact
• Number (N) interviewed afterhours and weekends
• A final year end “cleaned” dataset will be appended to the annual report
E. SAFER performance of case and outbreak investigations must comply with
completeness and timeliness metrics which MCDPH is subject to. Please see
Attachment E for further clarification.
F. The PI will return a cleaned data set of all case investigation data to MCDPH OE
once the annual report is completed and reviewed by MCDPH.

4. EXPECTATIONS AND METHODOLOGY
A. During Events and Exercises
The University of Arizona's Mel and Enid Zuckerman College of Public Health
(MEZCOPH) Student Aid for Field Epidemiology Response (SAFER) Team will
provide response aid to Maricopa County Department of Public Health (MCDPH)
during events, outbreaks, and emergencies. The SAFER Students will function under
the direction of OE in coordination with the Office of Preparedness and Response
(OPR). SAFER students serve on the field epidemiology team during various large
events in Maricopa County including sporting events, Annual Fiesta College Bowls,
Phoenix International Raceway (PIR) events, and other situations when the decision
is made by OE to activate the team.
B. Assist with Outbreaks and Enteric Disease Investigations, Data Collection and
Analysis
During routine enteric disease investigations, pandemics, and other large outbreaks,
the students will function under the direction MCDPH OE for any number of
supportive functions including, but not limited to: survey creation, phone interviews,
medical record requests and chart extraction, email and web based interview
distribution and collection. Analysis of data is limited to that required for routine
quality assurance analysis to ensure the IGA requirements are being met and the
annual SAFER report being produced. Additional descriptive and/or complex data
analysis may also be completed in collaboration with OE following a written request
and permission granted. Please see Section 5.B. for clarification.
In order to increase timeliness and efficiency on reports, it is understood by MCDPH,
the students will enter data into an online database and the faculty Pl/Director,
GRAs, or other student workers will be responsible for transfer of the data into
Medical Electronic Disease Surveillance Intelligence System (MEDSIS) on behalf of
MCDPH. Priority of data collection and data entry will be determined by MCDPH.
For outbreaks and single case investigations, the data should be collected from the
clients/cases using MCDPH supplied forms. Any additional data collected which is
not included on the original MCDPH form shall be included in the online database
only with the express permission of MCDPH. MCDPH shall have full access to and
the right to examine, copy, and make use of any and all such data. To achieve an
optimal response rate during routine disease case investigations the following
contact methodology will be attempted.
I. For cases with contact phone numbers and address:
A. A maximum of up to three (3) attempted phone calls with
varied time of day contact (i.e.: morning, evenings and
weekends)
B. An MCDPH standardized contact letter sent to address if
phone contact is unsuccessful after three (3) attempts
II. MCDPH will provide updated contact information for cases. If for any
reason the contact information is incorrect or missing the follow steps
should be taken:

A. For cases with contact phone numbers, but no contact
address: A maximum of up to three (3) attempted phone
calls
B. For cases with contact address, but no contact phone
number (after MCDPH search): A MCDPH standardized
contact letter sent to address
C. For cases with no contact information: Contact provider to
retrieve contact address and/or phone number MCDPH will
provide updated contact information when possible.
5. RIGHTS IN DATA
A. Uses of Data:
A.1. Carefully restrict use and access of information to those designated by
MCDPH.
A.1.A. No data, aggregate or line list, may be released by SAFER.
A.1.B. Analysis authorized under this IGA is limited to the minimum
necessary to ensure completion of contract requirements as
outlined in Section 3. Any analysis or use of the data beyond
that, even by parties previously considered covered by this
IGA (PI, GRAs, SAFER students), must be submitted to
MCDPH OE at http://www.maricopa.gov/epi and will be
considered similar to all other academic institution data
requests in compliance with OE policies and procedures.
A.1.C. If SAFER receives a request for data or information related to
activities covered under this IGA, they should direct the party
to http://www.maricopa.gov/epi and MCDPH OE will work with
that party in accordance with OE policies and procedures.
A.2. The data shall only be accessed at locations which are considered physically
secure for data access and use including, specified SAFER call center or
MCDPH offices. The data shall not be accessed at any public venue.
A.3. For submission of abstracts, the abstract must be sent to MCDPH OE at
least seven (7) days prior to submission to review and comment on.
A.4. For publications and presentations external to the University of Arizona
which present MCDPH data or reference work done for or with MCDPH
under this or past IGAs, notification must be made and all materials
submitted for review to MCDOH OE at least thirty (30) days prior to
submission.
A.5. For studies, investigations, or field experiences which lead to draft
manuscripts, the SAFER student(s) most involved and/or Pl as well as OE
staff will be invited to contribute and have an author position relative to the
amount of work contributed to the manuscript.

6. SECURITY OF CONFIDENTIAL INFORMATION
A. The Contractor shall monitor the use of all Public Health Data disclosed by MCDPH
under this IGA, including but not limited to Personal Identifying Information, and to
carefully restrict the use and disclosure of such information as provided for herein.
B. Survival of Duty to Protect Confidential Information
It is understood and agreed by the Parties that the obligations set forth in this Section
6, shall survive the expiration or termination of this IGA, except as expressly provided
for herein.
C. Minimum Safeguards for Protected Health Information
The Contractor shall carefully restrict use and access of MCDPH Personally
Identifying Information solely to Authorized Persons and shall ensure that the
Contractor implements the following minimum safeguards to prevent a Security
Breach in a manner consistent with the requirements of this IGA or applicable law.
Contractor safeguards shall, at the minimum, require that the Contractor and its
Authorized Persons:
C.1. Prohibit Personally Identifying Information supplied under the terms of this
IGA from being released or disclosed to anyone not working on MCDPH data
collection and analysis as an Authorized Person.
C.2. Secure all printouts containing individual identifiers or confidential data in a
locked vault, file cabinet or other method reasonably necessary to protect the
confidential information.
C.3. Store all Public Health Data shared pursuant to this IGA only on secured
servers or encrypted devices within MCDPH, which, at the termination of this
IGA, shall be securely deleted upon the conclusion of this IGA consistent with
the requirements of this IGA and applicable law.
C.4. Provide MCDPH with a description of the security measures that are in place
to maintain the confidentiality of the data being received under this IGA.
C.5. Provide MCDPH, upon request, with a current list of Authorized Persons, and
evidence that all Authorized Persons who have access to the Public Health
Data shared under this IGA have participated in any required training and
signed any documents that are necessary to keep both MCDPH and the
Contractor in compliance with HIPAA, including but not limited to, user
confidentiality affirmation statement, HIPAA training certification or other
HIPAA related compliance documents, if applicable.
C.6. Provide or continue to provide MCDPH with a copy of the contractor's
procedure for the notification of MCDPH of any Security Breach, which shall
include a requirement that any user of the Public Health Data shared under
this IGA shall immediately notify a designated individual at MCDPH of any
known or reasonably suspected Security Breach.
C.7. Maintain a log of all encrypted devices and identification numbers of those
devices that are authorized to transmit, receive or store the Public Health

Data shared under this IGA, until the data is destroyed. MCDPH may
request a copy of the log at any time during the term of the IGA or until the
data is destroyed.
C.8. Make clear to all Authorized Persons and other employees with a need to
know that the Contractor is prohibited from storing Public Health Data on
non-encrypted flash drives, CDs, external drives, smart phones or other non-
networked hard drives.
C.9. Provide MCDPH prompt proof of the complete destruction of the original data
and any copies or subsidiary data sets containing Personally Identifying
Information that are developed from the original data upon the conclusion of
this IGA or at such time that such destruction is required by applicable law
and in compliance with County record retention policies. Proof of destruction
may include a certificate of destruction.
D. Security Breach
In the event of a Security Breach, pursuant to A.R.S. § 44-7501, MCDPH and the
Contractor agree to collaborate with each other on the investigation, mitigation,
remediation and, if necessary, breach notification of citizens. Pursuant to A.R.S. §
41-3507, MCDPH shall notify ADHS and the Arizona Strategic Enterprise
Technology (ASET) Statewide Information Security and Privacy Office (SISPO)
immediately upon becoming aware or receiving notice of a Security Breach.
7. AMENDMENTS AND EXTENSION
All amendment to this Agreement must be in writing and signed by both parties.

SECTION IV COMPENSATION
1. COMPENSATION
REIMBURSEMENT RATE is $134,000 per year.
1.1. Subject to availability of funds, the County shall pay the University of Arizona for the
services described herein in the not-to-exceed amount of $134,000 per year.
1.2. Compensation will be reimbursed on a monthly fixed rate. Any changes to funds
allocated for this Agreement shall be adjusted via Amendment in writing and
signed by both parties.

ATTACHMENT D
SAFER Salmonella Investigation Protocol
MCDPH will facilitate getting access to MEDSIS for Kristen Pogreba-Brown and SAFER Teaching
Assistants (TAs) and will provide MEDSIS training and user manuals. If students are to have access
to MEDSIS, Kristen Pogreba-Brown or designee should submit student names and signed user
agreements at the beginning of each semester for each student needing access to MEDSIS. Lia
Koski is a MEDSIS liaison who will be responsible for deactivating student MEDSIS accounts at the
end of their rotation. Students who are staying on as members of SAFER for more than one
semester should have that noted as soon as possible to prevent account deactivation.
MCDPH will provide Salmonella specific investigation training for SAFER students every semester.
This can be incorporated into the training session normally given at the start of the semester.
New Salmonella cases will be assigned by MCDPH triage to Kristen Pogreba-Brown or a current TA
which will then be distributed to SAFER students for investigation. Salmonella cases indicating the
case is a food handler, childcare worker or attendee, or healthcare worker will not be assigned to
SAFER but rather handled by MCDPH staff. The PI will have the responsibility for managing the
investigation queues in MEDSIS to ensure timely investigation of cases.
MCDPH will provide SAFER with an abbreviated Salmonella investigation form to be used during
case interviews, students will attempt to interview the case in accordance with protocol in attachment
E below.
If during the case investigation, the student determines the case is a food handler, childcare worker
or attendee, or is a healthcare worker. Also, if student(s) discover similarities between two (2)
unrelated cases (not members of the same household -examples included below).
• Consuming food or drink from the same establishment (excluding common venues
such as Taco Bell, McDonalds, Jack in the Box, etc. unless the unrelated cases
mention the same location).
• Visits to the same zoo, farm, pet shop, fair, water park, lake, river, social gathering,
sporting event, etc.
• Cases which have similar travel related exposures.
• Cases which reside in the same facility (assisted living, halfway house, etc. or attend
the same adult daycare facility).
SAFER will send an email to the designated and pre-determined list at MCDPH OE. This will be
done at the end of the shift, outlining all the following information (in the table format below):
MEDSIS ID Binational Other Ill New Contact Needed
Upon completion of the investigation, Kristen Pogreba-Brown or a TA will enter information
contained in the form into corresponding MEDSIS fields within one (1) day. Note: Students will be
using an abbreviated investigation form, more fields are available in the MESIS DSO (disease
specific observation), and fields not captured during the case interview using the abbreviated form
will be left blank. "Key" critical MEDSIS fields will be addressed during training; these fields should
be filled if at all possible. Any information/data collected during case interviews which does not have
a corresponding data entry field on the DSO shall be entered in the MEDSIS case notes section.
The case should then be closed and submitted to Arizona Department of Health Services (ADHS)
per MEDSIS training and protocol.

MCDPH will provide SAFER with an informational packet on Salmonella which can be emailed to the
person interviewed after obtaining their email address. For those cases who do not have an email,
SAFER will mail packets via USPS.
The informational packet includes instruction and a seven (7) day food history to be completed by
the case and returned to ADHS via email or USPS. SAFER will request the person not to reveal their
salmonella diagnosis when sending via email, simply complete the history and send to ADHS as
indicated. ADHS will enter information gained from the returned seven (7) day food history into
MEDSIS.

ATTACHMENT E
Completeness and Timeliness Metrics
In accordance with the MEDSIS data entry and investigation guidelines, there are standards for the
data entry and investigation of cases by SAFER. Below only apply to Salmonella and
Campylobacter cases.
Initial case entry
• Salmonella and Campylobacter cases associated with a food-handler, day care worker or
attendee, or healthcare worker must be entered within one working day.
• Salmonella and Campylobacter cases not associated with a special population must be
entered within three working days.
Control action within appropriate time frame
• For Salmonella only, control action should be initiated within three business days of the initial
case report to public health. This does not mean the date SAFER was notified, but rather
from when the initial case report was received as indicated above.
Key fields for data entry include: (Salmonella and Campylobacter)
• Morbidity
• Onset date or Diagnosis date
• Date investigation started
• Time investigation started
• Case management (tab)
o Case standing
o Case contacted
Additional Salmonella-specific key fields include:
• Diarrhea
• Hospitalized
• Food handler
• Childcare
• Contact with animals
• Poultry
• Travel
• Control action- Date first control action initiated
• Time of initial control action
• Education provided
Case Classification:
Will be entered in MEDSIS for salmonella and campylobacter cases in accordance with the current
classification defined by Arizona Department of Health Services Case Definitions For Public Health
Surveillance found at the following web location:
http://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#investigations-case-
definitions