UMN Enterprise OnCore New User Request To request a user account in the OnCore Enterprise System, complete this form and submit it to the Enterprise OnCore Office. Note: This form is for UMN, UMP, and Fairview employees only e-mail: [email protected] Fax: 612-626-7227

General Information: Last Name:______________________________ First Name:_____________________________ Middle Initial:________________ UMN Staff ID# (UMN staff only):________________________________________________________________________________ E-mail:______________________________________________________________________________________________________ Phone:______________________________________________________________________________________________________ Job Title:____________________________________________________________________________________________________ Department:_________________________________________________________________________________________________ Supervisor’s Name:____________________________________________________________________________________________ Will you be assigned to studies in OnCore as (only check if one of the following applies): ☐ Principal Investigator, please provide Fairview EMR Caregiver ID (If known):_____________________________ ☐ Clinical Research Coordinator, please provide Fairview EMP45 ID (If known):_____________________________

OnCore Access Information*: Provide the name of an existing user with the access the new user requires: Existing user’s full name (Last, First):_________________________________________________ Existing user’s e-mail address:______________________________________________________ *If you complete the two fields above, please DO NOT fill out the following. Please skip to the Page 2 (Training) OR: Provide the following access information (Only if you did not list an existing user above): Organizational Unit (Select all that apply): ☐ Masonic Cancer Center: select this option if the user works with or needs to access oncology studies. (May require MCC application/approval). ☐ Cardiovascular: select this option if the user works with or needs to access cardiovascular studies ☐ UMN TC General: select this option if the user works with or needs to access studies outside of cardiovascular or oncology ☐ M Health Community: select this option if the user works with or needs to access Fairview Research or Community studies Access Roles (Select all that apply):

☐ General Access: user requires access to enter new protocols, to update protocol information and status, enter new subjects, and update subject statuses and visit data.

☐ Project manager: user only requires access to enter new protocols or manage protocol-level data.

☐ Clinical Research Coordinator: user only requires access to enter new subjects and manage subject data.

☐ Investigator: user is a Principal or Co-Investigator who

☐ Budget Analyst: user requires access to view protocol information and review pricing. ☐ Accountant: user requires access to view information relevant to financials management for protocols.

☐ Service Provider: user requires access to enter research pricing

information, provide account numbers, or set up research lab slips.

☐ SPA: user requires access to view data for Sponsored Projects

Administration. requires access to view protocol and subject data. ☐ Other: Specify here: ___________________________ ☐ Regulatory Specialist: user requires access to enter IRB _____________________________________ information or manage other review data. ______________________________________ Access Scope: ☐ As A ssigned: Access limited to protocols on which the user is listed as “staff." ☐ Management Group: Access limited to protocols within a specific management group. (This is most common for general users). Specify Group(s) (list available here: z.umn.edu/OnCoreMGs): _____________________________________________________________ ☐ OU: Access to all protocols within the Organizational Units chosen above. (This broad access is rarely assigned and most often reserved for those who work across multiple areas, such as a program director).

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Training: HIPAA and Data Security: Please check the boxes to confirm you have completed the following: ☐(HIPAA16) HIPAA Training ☐(PJPD16) University Information Security Awareness

OnCore Training (Select One): ☐ I have completed OnCore training (this will be verified by OnCore staff). ☐ I have not completed OnCore training or I would like additional training (OnCore staff will contact you to set up training before access is granted). NOTE: OnCore training is intened for those who have an understanding of research workflows and job responsibilities. Please complete general training for your position before requesting access to OnCore. CTSI offers central resources for research personnel training: http://www.ctsi.umn.edu/education-and-training

Authorizing Signatures:

After completing the appropriate sections above, collect all required signatures and return to [email protected] or by fax to 612-626-7227. Once an account has been created, you will be contacted by e-mail with your log-in information.

New UMN OnCore User: I verify that all data entered on this form is correct and confirm that I require the indicated access to perform my duties. I confirm that I will adhere to the OnCore Access policy. I understand that my activities in OnCore may be monitored for data security purposes.

Signature: ___________________________________________________ Date:__________________ Supervisor or Designated Area Approver (Indicate below): I verify that the above data is correct and confirm that this employee requires the indicated access to perform his/her duties. Signature: _____________________________________________________Date:________________

Please check one:

☐

Supervisor (Non-Designated Area Approver). Please print name:

____________________________________________________ ☐

Designated Area Approver (Select Below): ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Amanda Galster, Pediatrics Brenda Prich/Anne Hopper/ Lisa Johnson, CTSI Emily Caldwell, Cardiovascular Michelle Hintz, Department of Medicine Kris Meyer, Department of Medicine (Accountants Only) Denise Windenberg, FMCH, OVNS, and Dermatology Nonye Harcourt, Neurosurgery Anne Mochovak, CTFS Jill Cordes/Krista Goldsmith, Fairview Research Administration

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