The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

U8jTXaf74S3WGCXh44P7pZmb7UC7jbjqCzAMBFyshKMrut7A2b6XuqYXzaEuaxaio

Office of Clinical Reseach (OCR) Services Request Form

Welcome to the OCR's REDCap Survey! Please indicate the services and needs you require below. Someone from the respective services will reach out to you to for follow up.

Thank you so much!

First Name:

* must provide value

Last Name:

* must provide value

Email Address:

* must provide value

Department:

* must provide value

Other Department:

* must provide value

OCR Service Need

* must provide value

Feasibility

Financials

OnCore

Participant Payments

Training and Access Requests

Feasibility Service Line Requests

-Confidentiality Agreements (CDA/NDA) Submission
-Feasibility survey help/completion
-Metrics
-Shared Investigator Platform (SIP)
-TriNetX Cohort Query Discovery

Feasibility Services

Please indicate the type of service(s) you need from Feasibility:

* must provide value

Confidentiality Agreements (CDA/NDA) Submission

Feasibility survey help/completion

Metrics for leadership

Shared Investigator Platform (SIP) Help

Shared Investigator Platform (SIP) Profile Registration

TriNetX Cohort Query Discovery

Please provide information on PI, protocol number or title, sponsor name, and sponsor email:

* must provide value

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Please upload your CDA/NDA/Addendum here:

* must provide value

Upload file

Please upload your feasibility questionnaire here:

* must provide value

Upload file

Please explain what Metrics you are looking for:

* must provide value

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What do you need help with regarding your SIP profile?

* must provide value

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The Organizational Manager for SIP will reach out to you soon regarding your SIP profile registration. Please make sure that your name and email address are entered in this survey either in the fields above or in the comment below:

In the meantime, do you have any questions, comments, or concerns regarding SIP?

* must provide value

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Please provide details on what you are looking for your TriNetX Cohort Query Discovery search here:

* must provide value

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Financial Requests:

1. Pre-Award Services (OCR will create minimum protocol shell, calendar, budget and negotiate budget with sponsor)
2. A New Calendar Build (OCR will create the calendar, this will be for a new study. Department will create the protocol shell)
3. An Amendment to a Calendar (A change to the calendar, OCR will create a new version of the calendar)
4. Post Award Services (OCR will review visits, create invoice for sponsor, send invoice, receive and reconcile payment, follow up on old invoices)
5. Research Billing Review (OCR will perform RBR based on information in OnCore)

Financial Services

Please indicate the type of Financial service(s) you need from Finance:

* must provide value

Pre-Award Services (OCR will create minimum protocol shell, calendar, budget and negotiate budget with sponsor)

A New Calendar Build (OCR will create the calendar, this will be for a new study. Department will create the protocol shell)

An Amendment to a Calendar (A change to the calendar, OCR will create a new version of the calendar)

Post Award Services (OCR will review visits, create invoice for sponsor, send invoice, receive and reconcile payment, follow up on old invoices)

Research Billing Review (OCR will perform RBR based on information in OnCore)

Do you have the new protocol for your study?

* must provide value

Yes

reset

Please upload the new protocol here:

* must provide value

Upload file

Do you have the amended protocol?

* must provide value

Yes

reset

Please upload the amended protocol here:

* must provide value

Upload file

Do you have a sponsor budget?

* must provide value

Yes

reset

Please upload the sponsor budget here.

* must provide value

Upload file

OnCore Requests:
-OnCore General Questions
-Custom Reporting Needs

OnCore Services

Please indicate the type of OnCore service(s) you need:

* must provide value

OnCore General Questions

Custom Reporting Requests

OnCore Access/Training

OnCore Access Termination

Please add your OnCore question(s) below:

* must provide value

Expand

Please add information of the custom report(s) that you require here, or upload a sample file of a report below:

* must provide value

Expand

Upload your custom report here:

Upload file

To request OnCore Access, please visit the REDCap Form, Request for OnCore Access, and click submit.

To terminate an existing OnCore user account, please visit the REDCap Form, Request for User Termination, and click submit.

Participant Payment Services

Please indicate the type of Participant service(s) you need:

* must provide value

Access/Training

New Project Request

Add users to an existing protocol

Request Pick up of Cards

Request a card replacement

New Account Number/FAO

Terminate Participant Payment Access for Staff

Terminate Participant Payment Protocol

If you would like to request Participant Payments for your project, please complete this REDCap survey: Advarra Participant Payments Project Request Form, and click submit.

If you would like to add a user to an existing protocol, please provide the User's full name, User's email, protocol number, and User's Role below:

User's Full Name:

* must provide value

User's Email:

* must provide value

Protocol Number to add User to:

* must provide value

Role of the User:

* must provide value

Participant check in

Financial Reviewer

reset

To request pick up of cards, please indicate the number of cards needed:

To request a card replacement, please provide the old ICN number and new ICN number below:

Old ICN number:

* must provide value

New ICN number:

* must provide value

To add a new account number (FAO), please provide the protocol number and effective data of the new FAO below:

Protocol number:

* must provide value

Effective date of new account # or FAO:

* must provide value

To terminate a staff member from participant payments, please provide the full name of the staff member that needs to be terminated from participant payments below:

* must provide value

To terminate a protocol from participant payments, please provide the protocol number that needs to be terminated from participant payments below:

* must provide value

Training and Access Requests

Please indicate the type of training(s) and access(es) you require from the options below:

* must provide value

OnCore Training/Access Request

Participant Payments Training/Access Request

The first step to request access is to fill out the OnCore "Request/Change Access form by clicking the link below. The appropriate trainings then will be assigned to you.

To request or change OnCore Access, please complete this REDCap survey: Request or Change for OnCore Access, and click submit.

To request Participant Payments Access, please provide your full name, email, and department below. Some one will reach out to you regarding Participant Payments Access.

Full Name:

* must provide value

Department:

* must provide value

Email:

* must provide value

If you need participant payment trainings and access, please provide your email:

* must provide value

Please provide information about your request, if needed:

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.