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UCDenver OnCore Access Request Form

Returning?

A A A

Please complete the OnCore Access Form below.

Thank you!

Type of OnCore Access being requested

* must provide value

First Name

* must provide value

Last Name

* must provide value

What type of change is being requested?

* must provide value

Change of role

Change of department

Change of management group

Change of organization

Other

CU Denver/CU Anschutz Email Address

* must provide value

Please describe the change requested to your OnCore account.

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Preferred Work Email Address

* must provide value

Work Phone Number

* must provide value

Title at the Institution

* must provide value

Where is your primary institutional affiliation (which institution is your employer and pays your salary)?

* must provide value

Please specify your primary institutional affiliation

* must provide value

What is your research role?

* must provide value

Study Team: PI, Research Manager, Coordinator, Data Manager, Pharmacist, etc.

Central and Hospital Research Administration PRE-APPROVAL REQUIRED (CRAO, CHCO Administration, UCHealth Administration)

Other

Will you see subjects at any of the following Locations?

* must provide value

Clinical and Translational Research Centers (CTRC) (non-CHCO)

Children's Hospital Colorado

Denver Health

UCHealth - Metro Denver

UCHealth - Northern Colorado

UCHealth - Parkview

UCHealth - Southern Colorado

VA Eastern Colorado Health Care System

University of Colorado Denver/Anschutz Medical Campus (non-hospital)

Childrens Hospital Colorado Computer ID Number

* must provide value

Do you work with subjects or samples from other non-affiliate institutions?

* must provide value

Yes No

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With which non-affiliate institutions will you be working? (Ex: The Ohio State University, etc.)

* must provide value

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Do you do oncology related research which involves the UCHealth - Metro Denver location?

* must provide value

Yes No

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Department

* must provide value

Additional Departments (if applicable)

Division/Research Groups

* must provide value

CCTO Disease Team

* must provide value

Brain

Breast

Endocrine

Gastrointestinal (GI)

Genitourinary (GU)

Gynecological (GYN)

Head and Neck

Lung

Melanoma

Phase I

POEMS

RAC/Finance

Radiation Therapy

Sarcoma

Transdisease

Additional division/research groups (if applicable)

Other division/research group not listed

Cancer Center - non-CCTO research group

* must provide value

Children's Hospital

Head & Neck SPORE

Hematology BMT

Lung SPORE

Medical Oncology

Neuro Oncology

OCRS Team

ORIEN

Otolaryngology

Pathology/Tissue Bank

Prevention and Control

Surgical Oncology

Survivorship

Urology Oncology

Young Women's Breast Cancer

Please answer the questions below to determine the type of OnCore access you will need

What is your role in clinical research?

* must provide value

Principal Investigator

Co-Investigator

Hospitalist

Pharmacist

Other study staff

Once you've fully completed this form, you will be granted the PI & View Only role within the production environment of OnCore.

Once you've completed this form, you will be granted the View Only role in OnCore's production environment

Will you need any other access to the system besides those already listed?

* must provide value

Yes No

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Supervisor Name

Supervisor Email

Supervisor Phone

Do you work with biospecimens that will be managed in OnCore?

* must provide value

Yes No

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Do you manage/supervise a team of Clinical Research Coordinators?

* must provide value

Yes No

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Will your responsibilities require you to submit study documents to an IRB?

* must provide value

Yes No

reset

Will you consent and enroll study subjects, schedule study visits, and meet with study monitors?

* must provide value

Yes No

reset

Will your role in OnCore be limited to entering subject study data?

* must provide value

Yes No

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Do you manage finances for a whole team?

* must provide value

Yes No

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Do you negotiate and/or prepare the study budget?

* must provide value

Yes No

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Do you send invoices, and receive and post receivables?

* must provide value

Yes No

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Will you be conducting initial calendar review?

* must provide value

Yes No

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Please describe your study role and access needs so we may determine the appropriate role.

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Additional Comments or access requests.

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Please list any study numbers related to your access request and/or additional access needs--e.g., mirroring staff account for Central and Hospital Research Administration (CHRA).

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NOTE: If your research needs also include entering UCHealth facilities or the use of the UCHealth instance of Epic, click here to complete the UCHealth Research Onboarding Application (Epic and Badging). Please note this will open a link in a new window.

Based on your answers above you will need to attend the following training(s):
Please copy this information for your tracking purposes

Protocol Management Training

Instruction offered via eLearning. OnCore support staff will email you with training information after we process this access request form.

Questions? Click here to email OnCore Support.

Subject Management Training

Instruction offered via eLearning. OnCore support staff will email you with training information after we process this access request form.

Questions? Click here to email OnCore Support.

Pre-Award Finance Training

Instruction offered via eLearning. OnCore support staff will email you with training information after we process this access request form.

Questions? Click here to email OnCore Support.

Post-Award Finance Training

Instruction offered via eLearning. OnCore support staff will email you with training information after we process this access request form.

Questions? Click here to email OnCore Support.

**BIOSPECIMEN MANAGEMENT TRAINING IS REQUIRED IF YOUR STUDY WILL USE ONCORE FOR SPECIMEN MANAGEMENT. Protocols where specimen banking is a primary outcome and samples will be housed on the Anschutz Medical Campus should use the OnCore Biospecimen Module.

Biospecimen Management Training

Instruction offered via eLearning. OnCore support staff will email you with training information after we process this access request form.

Questions? Click here to email OnCore Support.

UCHealth Medicare Coverage Analysis Training

UCHealth recommends that you complete the Medicare Coverage Analysis ULearn, the course that covers the Basics of Medicare Coverage Analysis. Upon completing this training, you will be able to:

Understand the importance of Medicare Coverage Analysis and how it relates to billing compliance.
Understand what makes a study a qualifying clinical trial.
Understand how routine costs versus non-routine costs are determined.

An MCA can serve as a guide and reference when you are administering an informed consent to a participant. MCAs can also:

Help determine routine costs and research-related costs.
Help study teams negotiate with sponsors.
Help conduct the trial in compliance with the protocol agreed to by the sponsor, the regulatory authorities, and IRB.

To self-register for this course, please click here. Login with your CU username as both the login username and password.

Questions? Click here to email UCHealth Research Specialists.

Signature of person, for whom access is requested (may not be signed by supervisor)

By signing, I agree that I have read and understand the UCD APS 6001 - Providing and Using Information Technology policy document, and have completed the University HIPAA training, if required. By signing, I agree to use OnCore only for work-related business and to not share my OnCore password with anyone. I will not let anyone use OnCore while I am logged in. I agree to only share the information obtained within OnCore with personnel who have a legitimate work-related need for the information. I understand failure to comply with the institution's policies and procedures may result in termination of access to OnCore. Validation of work-related need for anyone requesting OnCore access is required. If requesting access to electronic protected health information (ePHI) I attest to the need to use electronic devices that access, create, store, and receive ePHI AND that the electronic devices that I use with ePHI are fully encrypted with all security provisions applied.

While using OnCore to add a potential participant to a study, you may have access to PHI belonging to other health systems or clinics, such as MRNs, names, and birthdates. You are not permitted to copy, distribute, or use any information that is not specific to your role, the studies to which you are assigned, and the facility conducting the research. You agree to use your access to OnCore subject search only for the specific task of identifying and assigning consented participants to the appropriate study through the facility conducting the research. For example, if you are on the research team for a study being conducted at CHCO, CU only, or UCHealth, and you see that a consented participant has MRNs at another health care facility or other health system, you are only permitted to use the appropriate facility record to link the participant to the study. The only exception to this rule is if the study is being conducted at both CHCO and UCHealth and the participant has study activity at both hospitals. In this case, you must document consent in OnCore for both organizations independently for the same study. You are responsible for ensuring you use the correct record to link a consented participant to a study. Any other use of data in OnCore or gained from OnCore is strictly prohibited. Misuse of this data may result in a loss of your OnCore access and could result in other investigations or penalties, up to and including loss of employment or other disciplinary action, under privacy regulations and institutional policies.

By signing, I also confirm that the requested access roles and department/research group affiliations are appropriate for my job responsibilities and have been reviewed with my supervisor. I also agree to notify, or have my supervisor notify, OnCoreSupport@ucdenver.edu if my employment status changes.

* must provide value

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