UNIVERSITY OF COLORADO ONCORE ACCESS REQUEST FORM
University of Colorado OnCore Access Request Form
1.
2.
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.
Fill in the information below, print and sign where indicated, obtain your manager/supervisors signature and submit to: OnCore
Support, email: OnCoreSupport@ucdenver.edu
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 re ceive ePHI AND that the
electronic devices that I use with ePHI are fully encrypted with all security provisions applied.
USER INFORMATION
Name:
NEW REQUEST
UCD Log-in ID:
CHANGE REQUEST
Email:
Request Date:
Phone:
Effective Date:
Title:
Dept. Name:
Business Address:
Disease Group:
Supervisor Name:
OnCore Certification Required: Yes / No
Supervisor Email:
Oncore Certification Completed: (date)
Supervisor Phone:
Temp Assignment:
Start Date:
Stop Date:
USER SET-UP
OnCore Role
Requested:
Users may have more than
one role
*Special permission
required
** Certification not
required
BSM Admin *
Manager (MGR)
BSM Manager
Pre-Award Sign-off
BSM Staff
Primary Coordinator (PC)
Calendar Builder *
Principal Investigator (PI)
Clinical Research Coordinator (CRA)
PRMS
Compliance Sign-off
Regulatory Coordinator (REG)
Data Manager (DM)
Regulatory Sign-off
DSMC
Research Manager (RMGR)
Financial Coordinator Pre Award (FC-PRE)
Statistician (ST)
Financial Coordinator Post Award (FC-POST)
Study Data Monitor (MONITOR)
Financial Manager
View Only **
University of Colorado OnCore Access Request
Ver. 7 - 4/14/2020
UNIVERSITY OF COLORADO ONCORE ACCESS REQUEST FORM
Type of Access:
Check the appropriate options:
All Protocols
Production
Management Group Studies
Test
Train
Development
Validation
(List group/department)
Specific Protocols
(List protocols)
Access to identifying
protected health
information:
Access Request for the following environments”
Check One:
View and Edit PHI
View only access to PHI
No access to PHI
Applicant Signature:
Date
Supervisor Signature:
Data Owner/Dept.
Manager Approval:
Date
Date
OnCore Management or
CCB Signature:
Date
Upon completion of the form, scan and email a signed copy to: OnCoreSupport@ucdenver.edu. You will be notified
when your request has been granted.
TO BE COMPLETED BY ONCORE ADMINISTRATION
ONCORE ACCESS ACTIVATION
Access activation
process status
User info provided to OnCore OIT Support
Date:
Initials:
Staff added to OnCore Production
Date:
Initials:
Role(s) added to Staff in Oncore
Date:
Initials:
Staff activated
Date:
Initials:
Role changes made
ONCORE ENVIRONMENTS
Identify OnCore
environments user to
be added to
Production
Development
Train
Test
University of Colorado OnCore Access Request
Ver. 7 - 4/14/2020