Application Forms

An Application for Data has three (3) different modules:

  • the “Application for Data” form and data management plan (Module 1)
  • data services forms (Module 2)
  • variable lists for all requested datasets (Module 3).

Applicants must complete both forms in Module 1, and complete relevant forms in Module 2 for each required data service. Applicants must also provide completed variable lists in Module 3 for each requested dataset or collection. Resesarchers may be asked to provide research protocol (if available) and other documentation as required to support their request.

Please complete the modules relevant to your application and submit according to the submission instructions in the Application ProcessNon-research applicants are advised to contact ISPD Client Services for assistance.

Materials on this page are available for download – please acknowledge the WA Department of Health or Data Linkage Services as a source where applicable.


Module 1

Application Forms

Please note: the forms used for the draft application are the same as for the final application.

Module 2

Data Services

To properly understand your data request, for each requested service we require the following forms:

(Word Doc, 266KB)
If you are interested in linking external data (e.g., results of a survey) to the Department of Health WA datasets
(Word Doc, 279KB)
If you are interested in obtaining an extract of data from the Department of Health WA datasets.
(Word Doc, 243KB)

If you wish to give Data Linkage a list of addresses to be geocoded.

Electoral Roll 
Sample Selection

(Word Doc, 117KB)
If you require an identifiable sample from the WA Electoral Roll for mailout purposes.
Family Connections
(Word Doc, 277KB)
If you require genealogical relationships.
Matched Comparison
Group Selection

(Word Doc, 280KB)
If you require comparison or control populations for study cohorts to facilitate case-control studies. The Control Selection Guide may help you as well.
Identifiable Data
Third Party Linkage

(Word Doc, 261KB)
If you require an extraction of identifiable data to be sent to a third party linkage agency.
Aboriginal and/or Torres Strait Islander Flag
(Word Doc, 238KB)
If you require the use of a validated algorithm to generate an Aboriginal and/or Torres Strait Islander Status flag.
Privacy Preserving
Record Linkage

(Word Doc, 137KB)
If you are seeking hashed data for record linkage by third party linkage agencies.


Module 3

Variable Lists

Please complete the variable list for each dataset you require.

For variable lists that are not listed here, please contact ISPD Client Services.

Core Datasets

Birth Registrations (Excel, 711KB)
Death Registrations (Excel, 723KB)
Cause of Death Unit Record File (Excel, 707KB)
Electoral Roll Records (Excel, 702KB)
This is not required for identifiable extracts for mailouts – use the Electoral Roll Sample Selection form in Module 2.
Emergency Department Records (Excel, 721KB)
Hospital Morbidity Records (Excel, 733KB)
Mental Health Records (Excel, 725KB)
Midwives Notification System (Excel, 754KB)
MH NOCC Data (Excel, 712KB) (part of Mental Health measures)
WA Cancer Registrations (Excel, 705KB)

Other Datasets

Health and Wellbeing Surveillance System – Adult (HWSS) (Word Doc, 711KB)
Health and Wellbeing Surveillance System – Child (HWSS) (Word Doc, 713KB)
WA Notifiable Infectious Diseases Database (WANIDD) (Excel, 727KB)
WA Register of Developmental Anomalies – Birth Defects (Excel, 711KB)
WA Register of Developmental Anomalies – Cerebral Palsy (Excel, 709KB)
Child Development Service (CDS) (Excel, 733KB)


Application for Amendment – Data Amendment Form (Word Doc, 274KB)

An application for amendment may be required for linkage updates (where new data is provided for linkage), data extraction updates, addition of variables from previously approved datasets, or addition of new datasets to an existing application. Amendments are also required where there are changes to project methodology or personnel.

Please ensure that you have read our Amendments and Data Updates information, and have contacted both ISPD Client Services and the Department of Health Human Research Ethics Committee for advice, prior to any amendment requests and the submission of this form.


Application for Ethical Review (Department of Health Human Research Ethics Committee)

WA Health Ethics forms and other ethics documentation (e.g., amendments, confidentiality declarations) are submitted via the WA Health Research Governance System. Please see the Department of Health Human Research Ethics Committee website to find out more about ethical approval for research projects.


Draft Output Review – Draft Output Review Checklist (Word Doc, 260KB)

All outputs resulting from the analysis of Department of Health data must be submitted for Data Custodian review. To submit a draft output for review, please complete the Draft Output Review Checklist and email it, with the draft output, to

Please allow up to two full working weeks for feedback, or possibly longer if the output is very long (e.g., a student thesis).