The Listed Personnel Need Access to the Specified Site Descriptor And/Or the Monitoring

Clinical Trial Management System Access Form - Email completed form to DCRI Service Desk (dcriservicedesk.duke.edu)

This request must be approved by the Project Leader, Clinical Trial Manager or Lead CRA.

Please complete a separate form for each individual user.

Approved By: / Date:
Title:
User Name
(John Smith) / Organization Affiliation
(Select One) / RemoteEmployee ?
(Not located at DCRI) / Net ID
(JNB123) / Email Address / Phone
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Protocol Name(s) / Add/Remove
Protocol Access / Protocol Removal Date
(If applicable) / DCRI Departure Date
(If applicable) / Trip Report Approver / Unblinded
CRA
(If appropriate) / Access Type / Protocol Role
(Select one for each Protocol listed)
Add Remove
Add Remove
Add Remove
Add Remove
Add Remove
Add Remove
Add Remove
Add Remove / Click HereRead/Write/EditRead Only
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Click HereRead/Write/EditRead Only / Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)
Click HereAssociate DirectorAssistant DirectorCRA Non-TravelingCRA TravelingClinical Data IntegrationClinical Trial AssistantClinical Trial Coord (CTC)Clinical Trial ManagerContracts ManagementData ReviewerLead CRAOutcomesProject Lead AssistantProject LeaderQuality Assurance (QA)

The CTMS Access Form may also be used to remove Protocol access for a CTMS user. Complete the User Name, Protocol Name(s), Add/Remove Protocol Access, Removal Date and DCRI Departure Date (if applicable) fields only and email to DCRI Service Desk.

Version: 02-14-2016