SRE User Enrollment and Access Change Form
1. User Information
ICB
Tenant Name
User ID (Assigned by ITS) #
Request Type:
☐ New User
☐ Renewal
2. SRE Access Requested
Role
Request Date
☐ Access/Entitlement Modification
Application name and role
☐ Oncore
☐ Researcher
☐ Clinician
☐ Vendor
☐ Admin (Non research function)
☐ Nurse
Access Expiration Date
(Access for all shall not exceed
1 year from request date)
☐ Labmatrix
Click here to enter a date.
☐ CLEARPATH
☐ Apex
Please attach a second page for any specific requests.
3. SRE User Information
Last Name
Middle
initial
First Name
Work Email
Case Net ID
Work Phone
Alt. Phone
Address
City
ZIP Code
Department Name
Title
DOB
Employer: UH ☐ CCF ☐ CWRU☐ Other (specify) ☐ Click here to
Credentials:
MD ☐
DO ☐
RN ☐
PhD ☐
enter text.
4. SRE Applicant Acknowledgement
Please read and sign the “Considerations” before accessing the Secure Research Environment (SRE).
1. You must be located physically at Case Western Reserve University, University Hospitals, Cleveland Clinic Foundation
and/or MetroHealth. If you are not located in these facilities, please notify your tenant coordinator for a separate submission
form.
2. You agree to complete a Secure the Human training (contact security@case.edu).
3. You agree to use SRE in accordance with all applicable laws and Case’s “Acceptable Use of Computing and Information
Technology Resources” policy: http://www.case.edu/its/security/docs/aup.html
4. By signing below, a SRE applicant acknowledges that the information they have provided is accurate and that they will
follow applicable policies and standards.
5. The SRE is not connected to the Internet. In order to provide a secure controlled environment there is no outside
connectivity to websites and other network resources. This includes email, web search, social media, reference sites such as
wikis, or any other web property.
6. Data cannot be removed from the environment without request. In order to send data outside of the environment, a
request must be made to the tenant coordinator and designated tenant data manager.
7. Available applications inside the SRE. By default the SRE contains many applications that are needed to be productive. In
the event that an application is missing, you must contact the tenant coordinator for inclusion. All applications must be
licensed and have current support contracts.
8. Printing to a local printer. At this time, printing to a local printer must be completed via a managed file transfer (MFT).
You must make a PDF and then request for the tenant coordinator or data manager to export it for you.
9. Data transmissions are monitored. By default the SRE is monitored for malicious activity. This includes gaining access to
systems that you are not authorized to use. Please report any misuse to the ITS help desk.
10. I will not log on to the system in order to provide another person access to the system.
11. I agree to abide by Federal and Institutional HIPAA and HITEC guidelines and related activities concerning data and patient
information.
Version-2 (March 21, 2016)
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SRE User Enrollment and Access Change Form
Printed SRE User Name
ONCORE USERS
SRE User Signature
Supervisor Name (Print or Type Please)
Date
Click here to enter text. Phone Number Click here to enter text.
Supervisor Signature_________________________________________
To be completed by Supervisors (indicate access rights)
☐ Registering Subject
☐ Regulatory
☐ Read
☐ Data Entry
☐Financial
5. Tenant Coordinator Acknowledgement
By signing below, the tenant coordinator acknowledges that they have verified a SRE applicant’s identity and authorized requested
access and resource changes and provisioning.
Printed Tenant Coordinator Name
Tenant Coordinator Signature
Date
Tenant Coordinator Verification - User Access to:
☐ Oracle APEX ☐ CLEARPATH ☐ OnCore ☐ LabMatrix
(**If applying for CLEARPATH, User must sign the “Terms of Use”)
6. ITS Approval Acknowledgement
Printed ITS Official
Version-2 (March 21, 2016)
Request Approved:
ITS Official Signature
Yes:☐
No: ☐
Date
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