IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives effective as of the day and year set forth herein. University of Utah School of Medicine (“Data Steward”) By: (Signature of Steward”) “Data J. Michael Dean, M.D., MBA State EMS Official (“Covered Entity”) Associate Dean Date: By: (Signature of Recipient”) “Data N. Clay Mann, PhD, MS, MBA Professor Date: By: Title: (Signature) Name: Date: (Please Print)
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives effective as of the day and year set forth herein. University of Utah School of Medicine (“Data Steward”) By: (Signature of “Data Steward”) J. Michael Dean, M.D., MBA Associate Dean By: (Signature of “Data Recipient”) N. Clay Mann, PhD, MS, MBA Professor State EMS Official (“Covered Entity”) Date: Date: By: (Signature) Name: (Please Print) Title: Date:
Template-StateCoveredEntity-NEMSIS_v3_Data_Sharing_Agreement_Apr2018.docx