The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

JC9sgHwJTpKArJchymRUV9ds8GMswsI9v3byJx9nJ6TPyRS

OnCore CTMS User Agreement & Access Role Selection

Please complete this user agreement and select your OnCore access role.

All users must complete this prior accessing the system!

Last Name

* must provide value

First Name

* must provide value

Department

* must provide value

Job Title

* must provide value

Your Primary Organization Affliation

* must provide value

UMass Medical School

Umass Memorial Health Care

Health Alliance

Other

Primary Email Address

* must provide value

Select your OnCore Access Role (See descriptions)

* must provide value

Manage study, OnCore Protocol & IRB Status

Manage Subject Participation - e.g. subject visits

Manage Study Invoicing and Payments

Member of the Office Of Clinical Research

Memorial Hospital Billing Team (HB)

Principle Investigator & Sub-PI (PI): Oversight of Protocol Activities

Regulatory Coordinator (REG)

Work Phone Number

You Network Account ID (Username)

* must provide value

1. I understand that Confidential Information, including but not limited to information about the study protocol, Protected Health Information (PHI) and Personal Identifiable Information (PII) will be found in the clinical trial management system. I understand that I have an important role in protecting this information. An unauthorized disclosure or breach of Confidential Information affects the reputation of UMMS, the well-being of clients and patients, and may be a basis for disciplinary action up to and including termination of employment or matriculation.

* must provide value

I Agree

I Disagree

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2. I will not use, disclose, copy or transmit any Confidential Information except as authorized as part of my duties and according to established standards.

* must provide value

I Agree

I Disagree

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3. I will safeguard or destroy any Confidential Information as required by law, IRB guidance and/or UMMS Record Retention Policy if it is no longer required as part of my research.

* must provide value

I Agree

I Disagree

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4. I understand that it is my responsibility to follow the privacy and security policies and standards
established by UMMS and/or UMMHC or any other institution with which I am placed or with which I am
engaged by contract through my work at UMMS and/or UMMHC.

* must provide value

I Agree

I Disagree

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5. I will ensure any devices (desktop computer, laptop or mobile device) used to access confidential data are encrypted and password protected with passwords that meet UMMS or UMMHC policy requirements.

* must provide value

I Agree

I Disagree

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6. I will promptly report any observed or suspected privacy or security breach, including
unauthorized access to or disclosure of Confidential Information, to my supervisor and the
Information Security Office. I will promptly report the loss or theft of a portable device to the HelpDesk
and Campus Security.

* must provide value

I Agree

I Disagree

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7. I understand that I do not have any ownership rights in the Confidential Information. It is my
responsibility to follow the requirements listed above while working or studying at UMMS/UMMHC as well as after leaving UMMS/UMMHC and that it is my obligation to review and follow new privacy and security
standards circulated to employees and students.

* must provide value

I Agree

I Disagree

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YOU MUST AGREE TO ALL TERMS AND CONDITIONS!

Today's Date

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D-M-Y

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.