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User Access Request Form
Request Access to the ECHO ISPCTN Portal Dashboard, Studies, and Applications
Hidden
(AUTO) User Roles
Administrator
Editor
Author
Contributor
Subscriber
Researcher
Keymaster
Spectator
Blocked
Moderator
Participant
Professional Development
Student
Group Leader
Administrator 3rd Party Support
ACT NOWS Confidential
DCOC Access
ACT NOW Training Courses
ACT NOW OC Production
ACT NOW OC Train
UAR Level 1 Notify
UAR Level 1 Approver
UAR Level 2 Notify
UAR Level 3 Notify
UAR Level 2 Approver
UAR Level 3 Approver
UAR Beta Tester All Levels
UAR Portal Admin
UAR Data Admin
VDORA OC Production
VDORA OC Train
VDORA Confidential
VDORA RedCap
ISPCTN Site MT
ISPCTN Site HI
ISPCTN Site AK
ISPCTN Site NE
ISPCTN Site KS
ISPCTN Site OK
ISPCTN Site NM
ISPCTN Site AR
ISPCTN Site LA
ISPCTN Site MS
ISPCTN Site KY
ISPCTN Site WV
ISPCTN Site SC
ISPCTN Site DE
ISPCTN Site RI
ISPCTN Site NH
ISPCTN Site VT
ISPCTN Site OH
ISPCTN Site NIH
ISPCTN Site DCOC
Test User
ISPCTN Role - Clinical Investigator
ISPCTN Role - Pharmacist
ISPCTN Role - Research Coordinator
ISPCTN Role - Principal Investigator
ISPCTN Role - Co-Investigator
ISPCTN Role - Data Manager
DCOC Admin
Removed from ISPCTN
ISPCTN Role - Research Nurse
ISPCTN - Data Entry
ISPCTN Role - Regulatory Staff
ISPCTN Role - Study Monitor
ACT NOW ESC OC Production
ACT NOW ESC Confidential
iAmHealthy Confidential
iAmHealthy OC Production
ACT NOW Weaning Confidential
ACT NOW Weaning OC Production
Staging
iAmHealthy_redcapedc
VDORA1 Part 2 OC Test
VDORA1 Part 2 OC
ACT NOW ESC Intervention Training
iAmHealthy OC Train
ISPCTN Role - Interventionist
ISPCTN Role - Dietitian
ACT NOW ESC Intervention Train Approver
ESC Site FL-USF
ESC Site DE-Christiana
ESC Site HI-Kapiolani
ESC Site KS-CMH
ESC Site KS-Shawnee
ESC Site KS-UKMC
ESC Site KY-Louisville
ESC Site KY-StElizabeth
ESC Site LA-Tulane
ESC Site MA-Lahey
ESC Site MS-UMMC
ESC Site NC-Duke
ESC Site NE-UNMC
ESC Site NM-UofM
ESC Site NY-UB
ESC Site NY-UofRoch
ESC Site OH-Cincinnati-CHMC
ESC Site OH-Nationwide
ESC Site OH-TriHealth-GoodSamaritan
ESC Site OH-UnivHospitalsCleveland
ESC Site OK-UOHSC
ESC Site PA-CHOP
ESC Site PA-UofPenn
ESC Site RI-Nemours
ESC Site SC-MedUofSC
ESC Site SD-Sanford
ESC Site SC-SpartanburgRHS
ESC Site UT
Weaning Site CA-LLUMC
Weaning Site KS-Truman
Weaning Site KS-CMH
Weaning Site MA-UM
Weaning Site MI-WS
Weaning Site MO-WUSM
Weaning Site TN-UTHSC
Weaning Site LA-Tulane
Weaning Site AR-ACH
Weaning Site WV-WVU
Weaning Site NC-CCS
Weaning Site AL-UAB
Weaning Site IA-UI
Weaning Site NC-WMH
Weaning Site OH-NCH
Weaning Site OH-OSU
Weaning Site RI-WIH
Weaning Site SD-Sanford
Weaning Site NM-UNMHSC
Weaning Site PA-UofPenn
Weaning Site RTI-International
ESC Assessor
Safety Assessor
iAmHealthy OC Test
Weaning Site OH-Metro
ACT NOW ESC Protocol Team
ACT NOW Weaning Protocol Team
Deactivated (or Duplicate) Account
MoVeUP Qualitative
KeyCloak Test
ISPCTN Role - Medical Site Monitor
Weaning Site LA-Ochsner Baptist
Weaning Site LA-Ochsner Kenner
Weaning Site AZ-Univ of AZ
Weaning Site PA-Penn State
Weaning Site FL-Orlando
Weaning Site NC-Wake Forest
Weaning Site MD-MedStar
Weaning Site CA-Sharp
BREATHE
MoVeUP App (Quantitative)
DSMB Read-Only
DSMB Read-Write
MoVeUP App EDC Access
BREATHE EDC
ISPCTN Site SD Avera
PRC Read-Write
PRC Read-Only
Weaning Site MI-CMS
Pending Portal User
BroncHI
BroncHI EDC
INTACT
INTACT EDC
RAMP
RAMP EDC
TWMB
TWMB EDC
SAMBA
SAMBA EDC
DCOC Editor
DSMB Read Closed
Training Dashboard ESC
Training Dashboard Weaning
Training Dashboard BREATHE
Who Needs ECHO ISPCTN Access?
Hidden
Would you like to upload a spreadsheet for multiple users?
Upload Bulk Users
This option allows you to upload a spreadsheet of unlimited users. However,
each bulk user must be submitted with the same study role and access rights.
Hidden
Bulk User Access Request
This option allows you to upload a spreadsheet of unlimited users. However,
each bulk user must be submitted with the same study role and access rights.
Upload Completed UAR Template
*
Use the "Choose File" button to locate your completed Bulk UAR template. Download the template using the link below.
Accepted file types: xls, xlsx, Max. file size: 16 MB.
Hidden
Single User Access Request
Request access for a single user.
Name of New ECHO ISPCTN Portal User
*
Enter the name and credentials of the user needing access to the ECHO ISPCTN Portal
First
Last
Credentials
User's Email
*
Affiliated Institution
*
Enter the institution or site with which this user is affiliated.
Is this user a non-ISPCTN member under an NPA?
*
Yes
No
Has the DCOC received a copy of the NPA from this user?
*
Yes
No
Hidden
Is this user's Institution affiliated with ECHO ISPCTN?
Yes, the institution is an affiliated ECHO ISPCTN institution
No, the institution is NOT an affiliated ECHO ISPCTN institution
Hidden
ISPCTN Role and Access Request
ECHO ISPCTN Role?
*
What is the role of this user as related to work associated with the ECHO ISPCTN?
Principal Investigator
Clinical Investigator
Research Coordinator
Data Entry Staff
Medical Site Monitor
Study Monitor
Is this request to add, revise, or remove user(s) access?
*
Please specify whether to add new user(s), revise user(s) access, or remove user(s) access to the portal.
Add New User(s)
Revise Existing User(s)
Remove Existing User(s)
Which areas should this user be removed from?
*
Remove from Portal and ALL Studies
Remove from ECHO ISPCTN Portal Website
Remove from ACT NOW ESC Project Access
Remove from ACT NOW WEANING Project Access
Remove from ACT NOW CE Project Access
Remove from BREATHE Project Access
Remove from iAmHealthy Project Access
Remove from MoVeUP App Project Access
Remove from MoVeUP Qualitative Project Access
Remove from Vitamin D (VDORA1) Project Access
What is this User Authorized to Access?
Please indicate ALL areas this user should be able to access:
Which dashboards should user have access to?
*
Choose from the
dashboards
below:
ECHO ISPCTN Portal Dashboard
ACT NOW ESC Project Access
ACT NOW WEANING Project Access
BREATHE Project Access
iAmHealthy Project Access
MoVeUP App Project Access
MoVeUP Qualitative Project Access
Vitamin D (VDORA1) Project Access
Who is managing ACT NOW ESC and/or ACT NOW WEANING for this user?
*
The user is working with NRN (RTI)
The user is working with DCRI (Duke)
I'm not sure
DCOC Internal Use
Please contact your site manager to determine the designated approver
before submitting this UAR
.
Hidden
Select Study-Specific Access Levels
Please select any additional access privileges for each study listed below.
NOTE: Portal Website access is the default access for each study.
ECHO ISPCTN Portal Dashboard
*
This includes the ECHO ISPCTN Portal Dashboard, general documents, pages, and online tools. Please list all areas this user is
authorized
to access.
Professional Development Only
ECHO ISPCTN Researcher Pages (full access)
ACT NOW ESC Project Access
*
Please check the areas that this user is
authorized
to access ACT NOW ESC data.
Research Portal Dashboard (ACT NOW ESC)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
ACT NOW ESC - Intervention Training (ESC)
ACT NOW ESC - Intervention Training (ESC)
ACT NOW WEANING Project Access
*
Please check the areas that this user is
authorized
to access ACT NOW WEANING data.
Research Portal Dashboard (ACT NOW Weaning)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
Hidden
ACT NOW CE Project Access
Please check the areas that this user is
authorized
to access ACT NOW CE data.
Research Portal Dashboard (ACT NOW CE)
Hidden
ACT NOW CE Activities Performed
Please check all activities this user is
authorized
to perform concerning ACT NOW CE data.
Data Entry
Signing Data Collection Forms
Review Access Only
BREATHE Project Access
*
Please check the areas that this user is
authorized
to access BREATHE data
Research Portal Dashboard (BREATHE)
Clinical Data Access (BREATHE)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
iAmHealthy Project Access
*
Please check the areas that this user is
authorized
to access iAmHealthy data
Research Portal Dashboard (iAmHealthy)
OpenClinica EDC (iAmHealthy)
OpenClinica Training EDC (iAmHealthy)
REDCap (iAmHealthy)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
MoVeUP App Project Access
*
Please check the areas that this user is
authorized
to access MoVeUp App data
Research Portal Dashboard (MoVeUP App)
Clinical Data Access (MoVeUP App)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
MoVeUP Qualitative Project Access
*
Please check the areas that this user is
authorized
to access MoVeUp Qualitative data
Research Portal Dashboard (MoVeUP Qualitative)
REDCap (MoVeUP Qualitative)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
Vitamin D (VDORA1) Project Access
*
Please check the areas that this user is
authorized
to access Vitamin D (VDORA) data
Research Portal Dashboard (VDORA)
OpenClinica - Train (VDORA)
OpenClinica - Production (VDORA-Part 1)
OpenClinica - Production (VDORA-Part 2)
Study Specific Training Access Only
User has completed all mandatory trainings for this study
A revised DOA has been received by the DCOC for this study
Who is Authorizing This User?
Name of Authorizing Agent
*
Enter the name and credentials of the person granting authorization of the above user to access to the ECHO ISPCTN Portal.
First
Last
Credentials
Affiliated Institution
*
Enter the institution or site with which you are affiliated.
Email of Authorizing Agent
*
Enter the email of the person granting authorization of the above user.
Who is Submitting this Request?
Who is Submitting this Request?
*
I am the Authorizing Agent (same as above)
I am NOT the Authorizing Agent (more info required)
Your Name (the person completing and submitting this form)
*
Enter your name and credentials.
First
Last
Credentials
Affiliated Institution
*
Enter the institution or site with which you are affiliated.
Your Email
*
Enter your email so we can contact you if needed.
Please allow approximately 3-5 business days for your request to be processed and approved. You will be notified by email when your approval is complete.
Email
This field is for validation purposes and should be left unchanged.
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