Name
(Full name as it appears on UTMB directory)
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Today's Date
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Today Y-M-D
Phone Number
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Purpose of this request.
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Research Operational Support Process Improvement Other
Please indicate the phase of your research project as either Pre Award Preparatory to Research or Post Award Clinical Trial Support.
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Pre Award Preparatory to Research Post Award Clinical Trial Support
Enter user type
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Research Staff Research Admin Support Other Administrator Faculty Resident Student Contractor (Non-UTMB)
Service Requested(Please complete one form per request)
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REDCap
TriNetX
I2B2
ENACT Network/SHRINE
Consulting Services
Open Specimen
Other
Please provide a brief description of why you are requesting ______ .
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School Attending
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Graduate School of Biomedical Sciences School of Health Professions School of Medicine School of Nursing Other School of Public and Population Health
mention school name
Are you appointed to a UTMB position?(i.e., graduate assistant)
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Yes
No
Department
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Please complete the attached Non-Disclosure Agreement form and email to Velasquez, Lisa
Estimated end date as ______
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Today M-D-Y
Please indicate if the access request is for a class.
Yes
No
Please indicate the class name.
Today M-D-Y
UTMB Email Address
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Provide if Staff, Faculty, Resident or Student
Secondary Email
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Provide if non-UTMB employee
Please provide your UTMB Email address if available
Contractor - Company Name
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Contractor (non-UTMB)
Requester Department
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Academic & Student Affairs AHEC Anesthesiology Biochemistry & Molecular Biology Clinical Laboratory Sciences Community Outreach Correctional Managed Care Dean of Medicine Dermatology Enrollment Services Family Medicine Health Policies & Legislative Affairs Humanities & Basic Sciences Internal Medicine Microbiology & Immunology Moody Medical Library Neurology Neuroscience & Cell Biology Nutrition & Metabolism Obstetrics & Gynecology Occupational Therapy Office of Regulated Nonclinical Studies Office of the President Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Pharmacology Physical Therapy Physician Assistant Studies Poison Control Prevent Med/Community Hlth Psychiatry/Behavioral Sci Radiation Oncology Radiological Health Scis Radiology Rehabilitation Sciences Research Services Respiratory Care School of Allied Health Scis School of Nursing Science Education Surgery Other
mention dept name
For students please use requestors listed below:
School of Medicine lnevarez@utmb.edu School of Nursing rijmeyer@utmb.edu School of Public Health and Population jemperez@utmb.edu School of Health Professions debordel@utmb.edu Graduate School of Biomedical Sciences djreed@utmb.edu
Research Electronic Data Capture (REDCap) and REDCap Survey (referred to as REDCap) are electronic data capture tools provided by the Informatics Group /Institute of Translational Sciences ITS.
Please remember to acknowledge the Institute for Translational Sciences!
"This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (2UL1TR001439-06) from the National Center for Advancing Translational Sciences, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health."
The user understands that all REDCap user accounts must possess UTMB network login credentials to access REDCap.
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Yes
No
The user understands that sharing of their login credentials with other study personnel is not allowed.
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Yes
No
The user understands that access to REDCap projects may be dependent on the submission of a user rights matrix, which defines all users, their project role and their access to specific aspects of REDCap functionality. If the project is using REDCap to collect PHI, the data access worksheet should identify who has access to this information. This worksheet should be submitted by the project owner, and must include access information for all study personnel.
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Yes
No
The user understands that the REDCap project will be actively maintained per the timeframe described in the user's approved IRB protocol, or other timeframe designated and agreed upon by all parties. The REDCap project will be archived after this time frame has expired. Once archived, the data will remain in the database (unless requested by the user to be deleted permanently) and the study can be reopened as necessary with the appropriate approvals.
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Yes
No
The user understands that ITS REDCap Administrators will be responsible for: A. Approve and migrate all new projects into production B. Approve and implement any changes to project production forms.
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Yes
No
ENACT Secure Enclave and Limited Data Set Data Use Agreement
This Access Agreement (the "Agreement") is between you as an individual ("you" and "your") and the ENACT program ("we," "our," or "us"). You have been authorized by us to access ENACT secure Limited Data Sets (the "ENACT LDS") and certain data contained within the secure computing environment ("Enclave") under the terms of this Agreement. Your access to the ENACT LDS and Enclave is governed by federal and state laws, and your local CTSA Hub site's policies and procedures. We require that you sign this Agreement before you access the ENACT LDS or Enclave. When you sign this document, you agree to follow all the terms of this Agreement and acknowledge that it is enforceable against you. We may terminate your access to the ENACT LDS or Enclave at any time.
If you agree to the terms of this Agreement, please select 'Yes' to each statement below for access to the ENACT secure computing environment and associated datasets.
Use for Permitted Purpose. You may access the ENACT LDS and Enclave only for a lawful purpose ("Permitted Purpose") that has been authorized by the ENACT program. The Permitted Purpose includes research. You may only access the ENACT LDS and Enclave as necessary to accomplish the Permitted Purpose, and in a manner consistent with your local CTSA Hub site's policies and procedures, including, but not limited to, all data privacy and security policies and procedures (the "Policies"). The ENACT program may change the Policies or add to the Policies at any time, and it is your responsibility to be aware of all applicable Policies as they may exist at any time.
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Yes
No
Data may be private and sensitive and contain personally-identifiable information. Data may be protected by state and federal laws such as the Health Insurance Portability and Accountability Act and its implementing regulations (collectively, "HIPAA"), and we have a duty to protect it. You agree to comply with these laws in accessing data.
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Yes
No
You may not transfer or otherwise make available data to any person outside of the ENACT program. You also may not transfer or otherwise make available data to any person within the ENACT program unless it is specifically permitted as part of an approved Permitted Purpose.
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Yes
No
You may not access or use the data outside of the enclave (download, copy, or screenshot, etc.) and may not combine the data with other datasets unless it is specifically permitted by the ENACT program in writing. You may not print the data or access the data in a public forum with your screen visible to others.You will receive a password and User ID to access the ENACT LDS and Enclave. You must safeguard your password and User ID, and you must not share or otherwise disclose your password and User ID. If you believe your password or User ID has been compromised, you must contact the ENACT program administrators immediately. You are responsible for all activity taken with your password or User ID. You must implement any other reasonable safeguards you feel are necessary to prevent use or disclosure of data other than as expressly permitted by this Agreement.
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Yes
No
You agree that you will not attempt to learn the identity of the individuals who are the subjects of data. If you discover the identity of individuals who subjects in data, you will immediately inform the ENACT program administrators, and you agree not to contact those individuals.
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Yes
No
You agree that you will abide by the ENACT publication policy as written in Standard Operating Procedure (SOP) 5, found as part of the ENACT governance document and on the ENACT webpage at enact-network.org/resources/.
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Yes
No
If you believe that any person or entity is accessing or using the ENACT LDS or Enclave in an inappropriate manner, you must report these activities to your CTSA Hub site ENACT administrator or ENACT program administrators immediately. If you violate this Agreement, you will be subject to termination of your access to the ENACT LDS or Enclave, and possible criminal or civil liability. Your obligations under this Agreement continue after termination of your access to the ENACT LDS and Enclave. You acknowledge that violation of this agreement will result in notification to your home institution, which assumes full responsibility for the negligence of any of its investigators and will act in accordance with its own enforcement policies.
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Yes
No
CITATIONS
Please cite the publications below in study manuscripts using REDCap for data collection and management. We recommend the following boilerplate language:
This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UL1 TR001439) from the National Center for Advancing Translational Sciences, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Study data were collected and managed using REDCap electronic data capture tools hosted at University of Texas Medical Branch.1,2 REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources.
1PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.
2PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O'Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]
Link to articles: http://www.sciencedirect.com/science/article/pii/S1532046408001226 and https://www.sciencedirect.com/science/article/pii/S1532046419301261.
Preliminary data for grant application
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Yes No
Please enter IRB number if applicable
Principal Investigator email address:
Please provide PI email address if applicable
Upload Protocol/Project Documentation
Today M-D-Y