THIS IS A TEST RECORD
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View equation
M-D-Y
Purpose of request
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Protocol document access only
New OnCore CTMS user access
Modification to access of an existing user
Offboarding of departing employee
New SRC member
Protocol document access only
New OnCore CTMS user access
Modification to access of an existing user
Offboarding of departing employee
New SRC member
The "New SRC member" option should only be selected by the CRS SRC Coordinator .
Staff institution
* must provide value
Fred Hutch
Legacy Seattle Cancer Care Alliance
Seattle Children's Hospital
University of Washington
VA Puget Sound Health Care System
Fred Hutch
Legacy Seattle Cancer Care Alliance
Seattle Children's Hospital
University of Washington
VA Puget Sound Health Care System
Where is the staff member benefits eligible?
* must provide value
Not benefits eligible Contractor FHCRC-Administration FHCRC-Basic Sciences FHCRC-Clinical Research Division FHCRC-Human Biology FHCRC-Public Health Sciences FHCRC-Vaccine and Infectious Disease Legacy Seattle Cancer Care Alliance Seattle Children's UW SOM-Anesthesiology and Pain Medicine UW SOM-Bioengineering UW SOM-Bioethics and Humanities UW SOM-Biomedical Informatics and Medical Education UW SOM-Emergency Medicine UW SOM-Family Medicine UW SOM-Genome Sciences UW SOM-Global Health UW SOM-Immunology UW SOM-Laboratory Medicine UW SOM-Medicine-Allergy and Infectious Diseases UW SOM-Medicine-Cardiology UW SOM-Medicine-Dermatology UW SOM-Medicine-Gastroenterology UW SOM-Medicine-General Internal Medicine UW SOM-Medicine-Gerontology and Geriatric Medicine UW SOM-Medicine-Hematology UW SOM-Medicine-Medical Genetics UW SOM-Medicine-Medical Oncology UW SOM-Medicine-Metabolism, Endocrinology and Nutrition UW SOM-Medicine-Nephrology UW SOM-Medicine-Pharmacology UW SOM-Medicine-Pulmonary and Critical Care Medicine UW SOM-Medicine-Rheumatology UW SOM-Microbiology UW SOM-Neurological Surgery UW SOM-Neurology UW SOM-Obstetrics and Gynecology UW SOM-Ophthalmology UW SOM-Orthopaedics and Sports Medicine UW SOM-Otolaryngology/Head and Neck Surgery UW SOM-Pathology UW SOM-Pediatrics UW SOM-Psychiatry and Behavioral Sciences UW SOM-Radiation Oncology UW SOM-Radiology UW SOM-Radiology-Nuclear Medicine UW SOM-Rehabilitation Medicine UW SOM-Surgery UW SOM-Urology UW School of Dentistry UW School of Electrical & Computer Engineering UW School of Nursing UW School of Pharmacy UW School of Public Health UW School of Social Work Other (...)
Please specify where they are benefits eligible
* must provide value
Note:
If the staff member will be working on an
active billing study in the role of
Principal Investigator (PI) or
Clinical Research Coordinator (CRC) , they will need a
SER ID (for PIs) or an
EMP ID (for CRCs) .
If the staff member has the applicable ID you may enter it when prompted below.
If the staff member does
not have the requested ID, please contact the UW IT Help Desk at (206) 543-7012 or
mcsos@uw.edu .
Note:
Requested privileges may not be compatible with existing privileges.
Additional privileges are contingent on approval by the CTMS Program Office.
What type of access modification are you requesting?
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Add to existing privileges
Replace existing privileges
Remove existing privileges
Add to existing privileges
Replace existing privileges
Remove existing privileges
Please describe or list the privileges (e.g., permissions/access) to be removed.
* must provide value
Please provide justification and/or details about why these permissions are being added to or removed from this user's account.
(Certain permissions are limited among team members to prevent errors and/or delays in the study start up process.)
Which type(s) of research will the staff member be involved with or need access to documents for?
* must provide value
Please select the staff member's role
* must provide value
PI
Study Team
Clinic / Central Lab / Central Resource
PI
Study Team
Clinic / Central Lab / Central Resource
For the studies that the staff member will be working on, which organization(s) is the holder of funds?
Which organization(s) is the holder of funds for the studies the staff member will be working on?
Protocol document access user needs Management Group selection
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View equation
Staff first name
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Staff last name
* must provide value
Staff title
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Staff phone number
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This number will be available to all CTMS users.
Staff email address
* must provide value
STOP!
Please contact the Partner Access Liaison at partneraccess@fredhutch.org to proceed with Fred Hutch on-boarding. Access to OnCore will be requested by the Partner Access Liaison after Fred Hutch credentials have been obtained.
Notice for Seattle Children's Hospital staff:
Fred Hutch or UW credentials (e.g. username@fredhutch.org or username@uw.edu) are required for OnCore Access.
Is this email address also the staff member's UW NetID?
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Yes No
Staff UW NetID
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Does the staff member have UW credentials (e.g. username@uw.edu)?
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Yes No
Please provide the SCH staff member's existing UW username.
* must provide value
Does the staff member have Fred Hutch credentials (e.g. username@fredhutch.org)?
* must provide value
Yes No
Please provide the SCH staff member's existing Fred Hutch username.
* must provide value
Please check here to verify that you have read the instructions and would like to request Fred Hutch credentials for this SCH staff member.
Required for OnCore access
* must provide value
I agree
Fred Hutch Non-Employee Form
Fred Hutch Criminal Background Check Form
Confidentiality Agreement
TO BE COMPLETED BY CTMS PROGRAM OFFICE:
The new Fred Hutch account has been created and the credentials have been communicated to the new staff member
New FH account created for staff member * must provide value
Primary Office Location - UW
* must provide value
UWMC-Montlake - 1959 NE Pacific St
UW Health Sciences Building - 1959 NE Pacific St
UW Tower - 4333 Brooklyn Ave NE
University District Building - 1107 NE 45th St
UW South Lake Union Campus Center
Other
FHCC Campus - South Lake UnionUWMC-Montlake - 1959 NE Pacific St
UW Health Sciences Building - 1959 NE Pacific St
UW Tower - 4333 Brooklyn Ave NE
University District Building - 1107 NE 45th St
UW South Lake Union Campus Center
Other
Please specify the "Other" primary office location
* must provide value
Primary Office Location - SCH
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SCH Jack R. MacDonald Building - 1900 9th Ave
Seattle Children's Hospital - 4800 Sandpoint Way NE
Ben Towne Center for Childhood Cancer Research - 1100 Olive Way
Other
SCH Jack R. MacDonald Building - 1900 9th Ave
Seattle Children's Hospital - 4800 Sandpoint Way NE
Ben Towne Center for Childhood Cancer Research - 1100 Olive Way
FHCC Campus - South Lake UnionOther
Please specify the "Other" primary office location
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Staff physical address
* must provide value
Does the staff member work in a parallel office (CRBB/CTO, CRS/CRT, CTMS, Epic, IRO,
FHCC CRBO)?
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Yes No
Which office does the staff member work in?
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CRBB/CTO
CRS/CRT
CTMS
Epic
IRO
Other
CRBB/CTO
CRS/CRT
CTMS
Epic
IRO
Other
Note for FHCC CORS/CRT:
This option is for staff members who will
not act as
study team members (e.g. protocol coordinator, research manager, regulatory, etc.).
If the staff member will act as a study team member , please answer 'No' to the question above ("Does the staff member work in a parallel office?") and then choose the appropriate study team (or "Management Group") when prompted in a subsequent question below.
What is the name of the office?
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Name of a current staff member with permissions to mirror for the new staff member
(Optional)
Please describe, in detail, the activities the staff member will need to perform in OnCore:
* must provide value
Will the staff member be working on an active billing study in the role of Principal Investigator (PI) or Clinical Research Coordinator (CRC)?
* must provide value
Yes
No
If the staff member will act as a Principal Investigator on an active billing study, please provide their SER ID.
If the staff member will act as a Clinical Research Coordinator on an active billing study, please provide their EMP ID.
Will the staff member need to enter/edit study information in OnCore, or will they only need to view information?
* must provide value
Enter/Edit
View-Only
How many studies will the staff member need to enter and/or edit?
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One or two studies only (...)
All studies within selected study team(s) (...)
One or two studies only (...)
All studies within selected study team(s) (...)
How many studies will the staff member need to view?
* must provide value
One or two studies only (...)
All studies within selected study team(s) (...)
All studies within selected scope (...)
All studies in OnCore (DEPRECATED CHOICE)
One or two studies only (...)
All studies within selected study team(s) (...)
All studies within selected scope (...)
All studies in OnCore (DEPRECATED CHOICE)
What scope of studies will the staff member need to view?
* must provide value
Select all that apply.
Please enter the protocol number(s) of the studies the staff member will need to access.
* must provide value
(Separate multiple numbers with a comma)
Note:
Please confirm that the staff member really needs this broad scope of access for their work before selecting this option.
Note:
Typically the only groups who would need access to all studies in OnCore are CRBB, Investigational Drug Services (IDS), and PIs/Fellows .
Please confirm that the staff member really needs this scope of access for their work before selecting this option.
Which study team(s) -- or "Management Group(s)" -- will the staff member need to access studies for?
Study teams are referred to as "Management Groups" in OnCore.
The staff member will be granted access to all studies within the Management Group(s) selected here, with the permissions approved for them.
(Select only those necessary.) Management Group #1
* must provide value
AML Estey Asthma Inc. Clinical Research Center COMPASS-Health Affairs CRS Reg Ops-Health Affairs FH_Admin_Science Education Partnership FH_Bloom Lab FH_Burroughs FH_Clinical Immunogenetics Laboratory FH_Clinical Scholars FH_Cord Blood FH_COVID_CRC FH_CRD_Dudakov Lab FH_CRD_MShen Lab FH_CRS_RegOps FH_CRS_Shannon Dorcy FH_CTO/RCC FH_Fredricks Microbiome FH_Furlan Lab FH_Global Health Affairs FH_Haffner Lab FH_HB FH_HICOR FH_HPV Research Group FH_Huron FH_HVTN FH_Immunotherapy FH_Kiem FH_Lee Nelson Lab FH_Palliative Care/Elizabeth Loggers FH_PHS/Computational Biology FH_PHS_Biostatistics FH_PHS_Cancer Prevention FH_PHS_Epidemiology FH_PHS_Translational Research FH_Pulmonary FH_Survivorship FH_Transplant/CTN FH_VIDD_BBE FH_VIDD_IDS FH_VIDD_IVD FH_WHI HVTN-Oncology John Hansen Maloney Transplant Masumi Ueda Myelodysplasia & MPN Onc_Bloodworks Northwest Onc_CHORD Onc_CRS Coordinators Onc_FH_Admin_Science Education Partnership Onc_FH_Antibody Research Onc_FH_Auto Immune Onc_FH_Bloom Lab Onc_FH_Burroughs Onc_FH_CITN Onc_FH_Clinical Scholars Onc_FH_ClinicalImmunogenetics Laboratory Onc_FH_COMPASS Onc_FH_Cord Blood Onc_FH_COVID_CRC Onc_FH_CRD/MShen Lab Onc_FH_CRD/Radich Onc_FH_CRD_ClinicalBio Onc_FH_CRS/Reg Ops Onc_FH_Fredricks Microbiome Onc_FH_Furlan Lab Onc_FH_Geraghty Lab Onc_FH_Global Oncology Onc_FH_GVHD Onc_FH_Haffner Lab Onc_FH_HB Onc_FH_HICOR Onc_FH_Hill Lab Onc_FH_Hingorani Pancreas Onc_FH_Holmberg Onc_FH_HVTN Onc_FH_Immunotherapy Onc_FH_Joshua Hill Group Onc_FH_Kiem Onc_FH_Lee Nelson Lab Onc_FH_Mini Transplant Onc_FH_NCTN Onc_FH_Palliative Care/Elizabeth Loggers Onc_FH_Pathology Onc_FH_Paulovich Lab Onc_FH_Pediatric BMT Onc_FH_Petersdorf Lab Onc_FH_PHS/Biostatistics Onc_FH_PHS/Cancer Prevention Onc_FH_PHS/Collaborative Data Services Onc_FH_PHS/Computational Biology Onc_FH_PHS/Epidemiology Onc_FH_PHS/SWOG Onc_FH_PHS/Translational Research Onc_FH_Press Onc_FH_Pulmonary Onc_FH_Sangeeta Hingorani Onc_FH_Shared Resources Onc_FH_Soheil Meshinchi Onc_FH_Sorror Onc_FH_Steven Henikoff Lab Onc_FH_STTR Onc_FH_Survivorship Onc_FH_Syrjala Onc_FH_Transplant Biology Onc_FH_Transplant/Bleakley Onc_FH_Transplant/CTN Onc_FH_TST_Stirewalt Onc_FH_VIDD/BBE Onc_FH_VIDD/IDS Onc_FH_VIDD/IVD Onc_FH_WHI Onc_FH-Precision Oncology Onc_Huron Onc_SCCA_Community and Network Research Team Onc_SCH_SCRI/Cancer and Blood Disorder Center (CBDC) Onc_SCH_SCRI/Gastroenterology Onc_SCH_SCRI/Immunology Onc_SCH_SCRI/Infectious Disease Onc_SCH_SCRI/Palliative Care and Resilience Research Program (PCAR) Onc_SCH_Seattle Children's Therapeutics Onc_Seattle Institute for Biomedical and Clinical Research (SIBCR) Onc_TST_Ring_Lab Onc_UW_Anesthesiology and Pain Medicine Onc_UW_Breast Onc_UW_Breast Imaging Onc_UW_Cancer Vaccine Institute Onc_UW_CTO/RCC Onc_UW_Dermatology Onc_UW_Family Functioning Research Program Onc_UW_GI Onc_UW_GUMO Onc_UW_GUMO 2 Onc_UW_Gyn Onc_UW_HPV Research Group Onc_UW_Information_School Onc_UW_Laboratory Medicine Onc_UW_Med/Allergy and Infectious Diseases Onc_UW_Med/Cardiology_CTU Onc_UW_Med/Gastroenterology Onc_UW_Med/General Internal Medicine Onc_UW_Med/Hematology Onc_UW_Med/Hematology & Medical Oncology Onc_UW_Med/Hematology_Back Onc_UW_Med/Hematology_Giustini Onc_UW_Med/Medical Genetics Onc_UW_Med/Nephrology Onc_UW_Med/Nephrology_CICT Onc_UW_Med/Pulmonary and Critical Care Medicine Onc_UW_Neurological Surgery Onc_UW_Neurology Onc_UW_Obstetrics and Gynecology Onc_UW_Ophthalmology Onc_UW_Otolaryngology_Head/Neck Surgery Onc_UW_Pathology/Chen Lab Onc_UW_Pediatrics Onc_UW_Phase 1 Onc_UW_Psychiatry and Behavioral Sciences Onc_UW_Rad Onc Onc_UW_Radiology Onc_UW_Radiology/Chen Onc_UW_Radiology/Kinahan Onc_UW_Radiology/Nuclear Medicine Onc_UW_Radiology/O'Malley Onc_UW_Renal Group Onc_UW_Sabath Lab Onc_UW_Sarcoma Program Onc_UW_School of Nursing Onc_UW_School of Public Health/Health Services Onc_UW_SOM-Bioethics and Humanities Onc_UW_Surgery Onc_UW_Surgery/General Surgery Onc_UW_Surgery/Plastic Surgery Onc_UW_THOR Onc_UW_Urology Palliative Care Peds-Health Affairs PHS SWOG-Health Affairs Pollack Lab Radiology SCH_SCRI/Immunology School of Public Health Seattle Institute for Biomedical and Clinical Research (SIBCR) Stirewalt Tony Blau UW Gyn UW_Alzheimer's Disease Research Center (ADRC) UW_Anesthesiology and Pain Medicine UW Biology UW_Bloodworks Northwest UW_COVID_CRC UW_CTO/RCC UW_Dentistry/Oral and Maxillofacial Surgery UW_Epilepsy UW_General Internal Medicine UW_Global Health UW_Headache UW_Huron UW_Laboratory Medicine UW_Med/Allergy and Infectious Diseases UW_Med/Cardiology UW_Med/Cardiology_CTU UW_Med/Dermatology UW_Med/Emergency Medicine UW_Med/FamilyMedicine UW_Med/Gastroenterology UW_Med/Gastroenterology_Lee UW_Med/General Internal Medicine UW_Med/Gerontology and Geriatric Medicine UW_Med/Hematology UW_Med/Medical Genetics UW_Med/Metabolism Endocrinology and Nutrition UW_Med/Nephrology UW_Med/Pulmonary and Critical Care Medicine UW_Med/Rheumatology UW_Multiple Sclerosis UW_Neurocritical Care UW_Neurodegenerative UW_NeuroHIV UW_Neurological Surgery UW_Neurology UW_Neuromuscular UW_Neuro-Oncology UW_Obstetrics and Gynecology UW_Ophthalmology UW_Orthopaedics and Sports Medicine UW_Orthopaedics_HMC UW_Otolaryngology/Head and Neck Surgery UW_Pediatrics UW_Pharmacology UW_Positive Research UW_Psychiatry and Behavioral Sciences UW_Psychology UW_Rad Onc UW_Radiology UW_Rehabilitation Medicine UW_SCH_Seattle Children's Therapeutics UW_School of Dentistry UW_School of Nursing UW_School of Pharmacy UW_School of Public Health UW_School of Public Health/Health Services UW_School of Public Health/Pediatric Immunology UW_Sleep_Lab_De_La_Iglesia UW_Stroke UW_Surgery UW_Surgery/Burn UW_Surgery/Cardiothoracic UW_Surgery/General Surgery UW_Surgery/HMC Trauma UW_Surgery/Oral and Maxillofacial Surgery UW_Surgery/Plastic Surgery UW_Surgery/Transplantation UW_Surgery/Vascular Surgery UW_Urology UW_Virology Research Clinic VA Puget Sound Health Care System Other (...)
Request new Management Group
If your Management Group is not listed above please enter its name here. This new Management Group will be added to OnCore pending approval.
* must provide value
How are the studies conducted by this team categorized?
* must provide value
Select all that apply.
AML Estey Asthma Inc. Clinical Research Center COMPASS-Health Affairs CRS Reg Ops-Health Affairs FH_Admin_Science Education Partnership FH_Bloom Lab FH_Burroughs FH_Clinical Immunogenetics Laboratory FH_Clinical Scholars FH_Cord Blood FH_COVID_CRC FH_CRD_Dudakov Lab FH_CRD_MShen Lab FH_CRS_RegOps FH_CRS_Shannon Dorcy FH_CTO/RCC FH_Fredricks Microbiome FH_Furlan Lab FH_Global Health Affairs FH_Haffner Lab FH_HB FH_HICOR FH_HPV Research Group FH_Huron FH_HVTN FH_Immunotherapy FH_Kiem FH_Lee Nelson Lab FH_Palliative Care/Elizabeth Loggers FH_PHS/Computational Biology FH_PHS_Biostatistics FH_PHS_Cancer Prevention FH_PHS_Epidemiology FH_PHS_Translational Research FH_Pulmonary FH_Survivorship FH_Transplant/CTN FH_VIDD_BBE FH_VIDD_IDS FH_VIDD_IVD FH_WHI HVTN-Oncology John Hansen Maloney Transplant Masumi Ueda Myelodysplasia & MPN Onc_Bloodworks Northwest Onc_CHORD Onc_CRS Coordinators Onc_FH_Admin_Science Education Partnership Onc_FH_Antibody Research Onc_FH_Auto Immune Onc_FH_Bloom Lab Onc_FH_Burroughs Onc_FH_CITN Onc_FH_Clinical Scholars Onc_FH_ClinicalImmunogenetics Laboratory Onc_FH_COMPASS Onc_FH_Cord Blood Onc_FH_COVID_CRC Onc_FH_CRD/MShen Lab Onc_FH_CRD/Radich Onc_FH_CRD_ClinicalBio Onc_FH_CRS/Reg Ops Onc_FH_Fredricks Microbiome Onc_FH_Furlan Lab Onc_FH_Geraghty Lab Onc_FH_Global Oncology Onc_FH_GVHD Onc_FH_Haffner Lab Onc_FH_HB Onc_FH_HICOR Onc_FH_Hill Lab Onc_FH_Hingorani Pancreas Onc_FH_Holmberg Onc_FH_HVTN Onc_FH_Immunotherapy Onc_FH_Joshua Hill Group Onc_FH_Kiem Onc_FH_Lee Nelson Lab Onc_FH_Mini Transplant Onc_FH_NCTN Onc_FH_Palliative Care/Elizabeth Loggers Onc_FH_Pathology Onc_FH_Paulovich Lab Onc_FH_Pediatric BMT Onc_FH_Petersdorf Lab Onc_FH_PHS/Biostatistics Onc_FH_PHS/Cancer Prevention Onc_FH_PHS/Collaborative Data Services Onc_FH_PHS/Computational Biology Onc_FH_PHS/Epidemiology Onc_FH_PHS/SWOG Onc_FH_PHS/Translational Research Onc_FH_Press Onc_FH_Pulmonary Onc_FH_Sangeeta Hingorani Onc_FH_Shared Resources Onc_FH_Soheil Meshinchi Onc_FH_Sorror Onc_FH_Steven Henikoff Lab Onc_FH_STTR Onc_FH_Survivorship Onc_FH_Syrjala Onc_FH_Transplant Biology Onc_FH_Transplant/Bleakley Onc_FH_Transplant/CTN Onc_FH_TST_Stirewalt Onc_FH_VIDD/BBE Onc_FH_VIDD/IDS Onc_FH_VIDD/IVD Onc_FH_WHI Onc_FH-Precision Oncology Onc_Huron Onc_SCCA_Community and Network Research Team Onc_SCH_SCRI/Cancer and Blood Disorder Center (CBDC) Onc_SCH_SCRI/Gastroenterology Onc_SCH_SCRI/Immunology Onc_SCH_SCRI/Infectious Disease Onc_SCH_SCRI/Palliative Care and Resilience Research Program (PCAR) Onc_SCH_Seattle Children's Therapeutics Onc_Seattle Institute for Biomedical and Clinical Research (SIBCR) Onc_TST_Ring_Lab Onc_UW_Anesthesiology and Pain Medicine Onc_UW_Breast Onc_UW_Breast Imaging Onc_UW_Cancer Vaccine Institute Onc_UW_CTO/RCC Onc_UW_Dermatology Onc_UW_Family Functioning Research Program Onc_UW_GI Onc_UW_GUMO Onc_UW_GUMO 2 Onc_UW_Gyn Onc_UW_HPV Research Group Onc_UW_Information_School Onc_UW_Laboratory Medicine Onc_UW_Med/Allergy and Infectious Diseases Onc_UW_Med/Cardiology_CTU Onc_UW_Med/Gastroenterology Onc_UW_Med/General Internal Medicine Onc_UW_Med/Hematology Onc_UW_Med/Hematology & Medical Oncology Onc_UW_Med/Hematology_Back Onc_UW_Med/Hematology_Giustini Onc_UW_Med/Medical Genetics Onc_UW_Med/Nephrology Onc_UW_Med/Nephrology_CICT Onc_UW_Med/Pulmonary and Critical Care Medicine Onc_UW_Neurological Surgery Onc_UW_Neurology Onc_UW_Obstetrics and Gynecology Onc_UW_Ophthalmology Onc_UW_Otolaryngology_Head/Neck Surgery Onc_UW_Pathology/Chen Lab Onc_UW_Pediatrics Onc_UW_Phase 1 Onc_UW_Psychiatry and Behavioral Sciences Onc_UW_Rad Onc Onc_UW_Radiology Onc_UW_Radiology/Chen Onc_UW_Radiology/Kinahan Onc_UW_Radiology/Nuclear Medicine Onc_UW_Radiology/O'Malley Onc_UW_Renal Group Onc_UW_Sabath Lab Onc_UW_Sarcoma Program Onc_UW_School of Nursing Onc_UW_School of Public Health/Health Services Onc_UW_SOM-Bioethics and Humanities Onc_UW_Surgery Onc_UW_Surgery/General Surgery Onc_UW_Surgery/Plastic Surgery Onc_UW_THOR Onc_UW_Urology Palliative Care Peds-Health Affairs PHS SWOG-Health Affairs Pollack Lab Radiology SCH_SCRI/Immunology School of Public Health Seattle Institute for Biomedical and Clinical Research (SIBCR) Stirewalt Tony Blau UW Gyn UW_Alzheimer's Disease Research Center (ADRC) UW_Anesthesiology and Pain Medicine UW_Biology UW_Bloodworks Northwest UW_COVID_CRC UW_CTO/RCC UW_Dentistry/Oral and Maxillofacial Surgery UW_Epilepsy UW_General Internal Medicine UW_Global Health UW_Headache UW_Huron UW_Laboratory Medicine UW_Med/Allergy and Infectious Diseases UW_Med/Cardiology UW_Med/Cardiology_CTU UW_Med/Dermatology UW_Med/Emergency Medicine UW_Med/FamilyMedicine UW_Med/Gastroenterology UW_Med/Gastroenterology_Lee UW_Med/General Internal Medicine UW_Med/Gerontology and Geriatric Medicine UW_Med/Hematology UW_Med/Medical Genetics UW_Med/Metabolism Endocrinology and Nutrition UW_Med/Nephrology UW_Med/Pulmonary and Critical Care Medicine UW_Med/Rheumatology UW_Multiple Sclerosis UW_Neurocritical Care UW_Neurodegenerative UW_NeuroHIV UW_Neurological Surgery UW_Neurology UW_Neuromuscular UW_Neuro-Oncology UW_Obstetrics and Gynecology UW_Ophthalmology UW_Orthopaedics and Sports Medicine UW_Orthopaedics_HMC UW_Otolaryngology/Head and Neck Surgery UW_Pediatrics UW_Pharmacology UW_Positive Research UW_Psychiatry and Behavioral Sciences UW_Psychology UW_Rad Onc UW_Radiology UW_Rehabilitation Medicine UW_SCH_Seattle Children's Therapeutics UW_School of Dentistry UW_School of Nursing UW_School of Pharmacy UW_School of Public Health UW_School of Public Health/Health Services UW_School of Public Health/Pediatric Immunology UW_Sleep_Lab_De_La_Iglesia UW_Stroke UW_Surgery UW_Surgery/Burn UW_Surgery/Cardiothoracic UW_Surgery/General Surgery UW_Surgery/HMC Trauma UW_Surgery/Oral and Maxillofacial Surgery UW_Surgery/Plastic Surgery UW_Surgery/Transplantation UW_Surgery/Vascular Surgery UW_Urology UW_Virology Research Clinic VA Puget Sound Health Care System
AML Estey Asthma Inc. Clinical Research Center COMPASS-Health Affairs CRS Reg Ops-Health Affairs FH_Admin_Science Education Partnership FH_Bloom Lab FH_Burroughs FH_Clinical Immunogenetics Laboratory FH_Clinical Scholars FH_Cord Blood FH_COVID_CRC FH_CRD_Dudakov Lab FH_CRD_MShen Lab FH_CRS_RegOps FH_CRS_Shannon Dorcy FH_CTO/RCC FH_Fredricks Microbiome FH_Furlan Lab FH_Global Health Affairs FH_Haffner Lab FH_HB FH_HICOR FH_HPV Research Group FH_Huron FH_HVTN FH_Immunotherapy FH_Kiem FH_Lee Nelson Lab FH_Palliative Care/Elizabeth Loggers FH_PHS/Computational Biology FH_PHS_Biostatistics FH_PHS_Cancer Prevention FH_PHS_Epidemiology FH_PHS_Translational Research FH_Pulmonary FH_Survivorship FH_Transplant/CTN FH_VIDD_BBE FH_VIDD_IDS FH_VIDD_IVD FH_WHI HVTN-Oncology John Hansen Maloney Transplant Masumi Ueda Myelodysplasia & MPN Onc_Bloodworks Northwest Onc_CHORD Onc_CRS Coordinators Onc_FH_Admin_Science Education Partnership Onc_FH_Antibody Research Onc_FH_Auto Immune Onc_FH_Bloom Lab Onc_FH_Burroughs Onc_FH_CITN Onc_FH_Clinical Scholars Onc_FH_ClinicalImmunogenetics Laboratory Onc_FH_COMPASS Onc_FH_Cord Blood Onc_FH_COVID_CRC Onc_FH_CRD/MShen Lab Onc_FH_CRD/Radich Onc_FH_CRD_ClinicalBio Onc_FH_CRS/Reg Ops Onc_FH_Fredricks Microbiome Onc_FH_Furlan Lab Onc_FH_Geraghty Lab Onc_FH_Global Oncology Onc_FH_GVHD Onc_FH_Haffner Lab Onc_FH_HB Onc_FH_HICOR Onc_FH_Hill Lab Onc_FH_Hingorani Pancreas Onc_FH_Holmberg Onc_FH_HVTN Onc_FH_Immunotherapy Onc_FH_Joshua Hill Group Onc_FH_Kiem Onc_FH_Lee Nelson Lab Onc_FH_Mini Transplant Onc_FH_NCTN Onc_FH_Palliative Care/Elizabeth Loggers Onc_FH_Pathology Onc_FH_Paulovich Lab Onc_FH_Pediatric BMT Onc_FH_Petersdorf Lab Onc_FH_PHS/Biostatistics Onc_FH_PHS/Cancer Prevention Onc_FH_PHS/Collaborative Data Services Onc_FH_PHS/Computational Biology Onc_FH_PHS/Epidemiology Onc_FH_PHS/SWOG Onc_FH_PHS/Translational Research Onc_FH_Press Onc_FH_Pulmonary Onc_FH_Sangeeta Hingorani Onc_FH_Shared Resources Onc_FH_Soheil Meshinchi Onc_FH_Sorror Onc_FH_Steven Henikoff Lab Onc_FH_STTR Onc_FH_Survivorship Onc_FH_Syrjala Onc_FH_Transplant Biology Onc_FH_Transplant/Bleakley Onc_FH_Transplant/CTN Onc_FH_TST_Stirewalt Onc_FH_VIDD/BBE Onc_FH_VIDD/IDS Onc_FH_VIDD/IVD Onc_FH_WHI Onc_FH-Precision Oncology Onc_Huron Onc_SCCA_Community and Network Research Team Onc_SCH_SCRI/Cancer and Blood Disorder Center (CBDC) Onc_SCH_SCRI/Gastroenterology Onc_SCH_SCRI/Immunology Onc_SCH_SCRI/Infectious Disease Onc_SCH_SCRI/Palliative Care and Resilience Research Program (PCAR) Onc_SCH_Seattle Children's Therapeutics Onc_Seattle Institute for Biomedical and Clinical Research (SIBCR) Onc_TST_Ring_Lab Onc_UW_Anesthesiology and Pain Medicine Onc_UW_Breast Onc_UW_Breast Imaging Onc_UW_Cancer Vaccine Institute Onc_UW_CTO/RCC Onc_UW_Dermatology Onc_UW_Family Functioning Research Program Onc_UW_GI Onc_UW_GUMO Onc_UW_GUMO 2 Onc_UW_Gyn Onc_UW_HPV Research Group Onc_UW_Information_School Onc_UW_Laboratory Medicine Onc_UW_Med/Allergy and Infectious Diseases Onc_UW_Med/Cardiology_CTU Onc_UW_Med/Gastroenterology Onc_UW_Med/General Internal Medicine Onc_UW_Med/Hematology Onc_UW_Med/Hematology & Medical Oncology Onc_UW_Med/Hematology_Back Onc_UW_Med/Hematology_Giustini Onc_UW_Med/Medical Genetics Onc_UW_Med/Nephrology Onc_UW_Med/Nephrology_CICT Onc_UW_Med/Pulmonary and Critical Care Medicine Onc_UW_Neurological Surgery Onc_UW_Neurology Onc_UW_Obstetrics and Gynecology Onc_UW_Ophthalmology Onc_UW_Otolaryngology_Head/Neck Surgery Onc_UW_Pathology/Chen Lab Onc_UW_Pediatrics Onc_UW_Phase 1 Onc_UW_Psychiatry and Behavioral Sciences Onc_UW_Rad Onc Onc_UW_Radiology Onc_UW_Radiology/Chen Onc_UW_Radiology/Kinahan Onc_UW_Radiology/Nuclear Medicine Onc_UW_Radiology/O'Malley Onc_UW_Renal Group Onc_UW_Sabath Lab Onc_UW_Sarcoma Program Onc_UW_School of Nursing Onc_UW_School of Public Health/Health Services Onc_UW_SOM-Bioethics and Humanities Onc_UW_Surgery Onc_UW_Surgery/General Surgery Onc_UW_Surgery/Plastic Surgery Onc_UW_THOR Onc_UW_Urology Palliative Care Peds-Health Affairs PHS SWOG-Health Affairs Pollack Lab Radiology SCH_SCRI/Immunology School of Public Health Seattle Institute for Biomedical and Clinical Research (SIBCR) Stirewalt Tony Blau UW Gyn UW_Alzheimer's Disease Research Center (ADRC) UW_Anesthesiology and Pain Medicine UW_Biology UW_Bloodworks Northwest UW_COVID_CRC UW_CTO/RCC UW_Dentistry/Oral and Maxillofacial Surgery UW_Epilepsy UW_General Internal Medicine UW_Global Health UW_Headache UW_Huron UW_Laboratory Medicine UW_Med/Allergy and Infectious Diseases UW_Med/Cardiology UW_Med/Cardiology_CTU UW_Med/Dermatology UW_Med/Emergency Medicine UW_Med/FamilyMedicine UW_Med/Gastroenterology UW_Med/Gastroenterology_Lee UW_Med/General Internal Medicine UW_Med/Gerontology and Geriatric Medicine UW_Med/Hematology UW_Med/Medical Genetics UW_Med/Metabolism Endocrinology and Nutrition UW_Med/Nephrology UW_Med/Pulmonary and Critical Care Medicine UW_Med/Rheumatology UW_Multiple Sclerosis UW_Neurocritical Care UW_Neurodegenerative UW_NeuroHIV UW_Neurological Surgery UW_Neurology UW_Neuromuscular UW_Neuro-Oncology UW_Obstetrics and Gynecology UW_Ophthalmology UW_Orthopaedics and Sports Medicine UW_Orthopaedics_HMC UW_Otolaryngology/Head and Neck Surgery UW_Pediatrics UW_Pharmacology UW_Positive Research UW_Psychiatry and Behavioral Sciences UW_Psychology UW_Rad Onc UW_Radiology UW_Rehabilitation Medicine UW_SCH_Seattle Children's Therapeutics UW_School of Dentistry UW_School of Nursing UW_School of Pharmacy UW_School of Public Health UW_School of Public Health/Health Services UW_School of Public Health/Pediatric Immunology UW_Sleep_Lab_De_La_Iglesia UW_Stroke UW_Surgery UW_Surgery/Burn UW_Surgery/Cardiothoracic UW_Surgery/General Surgery UW_Surgery/HMC Trauma UW_Surgery/Oral and Maxillofacial Surgery UW_Surgery/Plastic Surgery UW_Surgery/Transplantation UW_Surgery/Vascular Surgery UW_Urology UW_Virology Research Clinic VA Puget Sound Health Care System
Additional Management Groups
If the staff member needs access to more than the Management Groups selected above list them here.
Which study team(s) (or "Management Group(s)") will the staff member need to access studies for?
Study teams are referred to as "Management Groups" in OnCore.
The staff member will be granted access to all studies within the Management Group(s) selected here, with the permissions approved for them.
(Select only those necessary.)
* must provide value
Archived Management Group selection:
Is user from a T3 Pilot study team (Cardiology CTU, Immunotherapy, Phase 1)?
View equation
What information will the staff member need to enter/edit in OnCore?
(Select all that apply.) Protocols
Enter or update protocol information, maintain protocol staff, complete task lists, enter summary accruals, submit to SRC
* must provide value
Yes No
IND/IDE (UW Non-Oncology)
Enter and update IND/IDE data in the PC Console > Main > IND/IDE tab (for UW Non Oncology protocols only)
* must provide value
Yes No
Will the staff member need to open studies to accrual in OnCore ?
* must provide value
Yes No
(Selecting 'Yes' will require an attestation from the user.)
Note:
By choosing 'Yes' you are acknowledging and approving that this staff member will have open to accrual permission for all studies they have access to .
Subjects
Register subjects, manage subject status lifecycles, enter subject activity dates
* must provide value
Yes No
Visit Management
Enter subject visits, SAEs, additional procedures, additional visits, subject related financial events, etc; required for protocols with Epic billing
* must provide value
Yes No
IRB reviews
Record IRB submissions, approvals, and modifications; enter IRB approved document information; upload and release protocol documents; update Other Committee Reviews
* must provide value
Yes No
Study Startup and Financial Management
Pre Award Management, Post Award Management, Invoicing & Receipts
* must provide value
Yes No
Which Financials Management actions will the staff member need to perform?
Pre Award Management : Review access to Calendars, Billing Grid, and Budget; sign off on Billing Grids and Budgets Post Award Management : View-only access to Calendars, Billing Grid, Budget, Subject Visit Tracking, and Invoices; enter subject related financial eventsInvoicing & Receipts : View-only access to Calendars, Billing Grid, Budget, and Subject Visit Tracking; enter subject related financial events, generate invoices, and enter receipts* must provide value
Will the staff member need to access Protected Health Information (PHI)?
* must provide value
Yes No
Will the staff member need to access protocol documents through document search?
* must provide value
Yes No
Will the PI need view-only access to study financial information?
* must provide value
Yes No
SRC member type
* must provide value
Full Member
Ad-Hoc Member
Expected first SRC meeting date
* must provide value
Today M-D-Y
Expected first SRC review assignment due date
Today M-D-Y
Advance phone training requested
* must provide value
Yes
No
Date requested for advance phone training
* must provide value
Today M-D-Y
Date access is to be revoked
* must provide value
Today M-D-Y
Reason for offboarding of staff member:
* must provide value
Reminder:
Study teams are responsible for ensuring staff lists are up-to-date for all required protocol staff roles. Staff no longer associated with the protocol must have an end date and replacement staff for each role must be entered. For more information on maintaining protocol staff lists in OnCore CTMS, please refer to the Protocol Staff Maintenance Work Instructions (OnCore login required) or email CTMS@fredhutch.org.
Is there a staff member replacing the departing staff member for all assigned protocol staff roles and protocols?
* must provide value
Yes No
CTMS will use this information to perform a "bulk swap" of the departing staff member assignments with the identified staff member. If the new staff member does not have OnCore access or does not have the required permissions for assigned role(s), please submit an Access Request Form.
Replacement staff first name
* must provide value
Replacement staff last name
* must provide value
Replacement staff title
* must provide value
Replacement staff email address
* must provide value
Note:
The CTMS office uses a ticketing system for all communications called Zendesk. To whom should all in-progress emails be assigned when the departing staff member is offboarded?
Zendesk replacement name
* must provide value
Zendesk replacement email address
* must provide value
Please enter the email of the person to contact if there are any additional questions.
* must provide value
Your first name
* must provide value
Your last name
* must provide value
Your email address
* must provide value
M-D-Y H:M
CTMS assessment/build contact
CTMS reviewer contact name
CRS reviewer contact name
CRS Customer Support contact
Submit
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