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ACTRI OpenClinica Configuration Request
Study Contact Information
Study Name
PI Name
PI Email address
IRB Number
First Name
Last Name
Email address
Phone Number
Contact Role: (Study Coordinator, Administrator etc.)
Has the study been approved by IRB?
Yes
No
IRB is in progress
Study has the following data compliance and configurations needs
CFR Part11 Compliance
UCSD Epic - Electronic Health Records Systems data integration
Data Types Approved for Transfer to EDC for case report forms
Observations
Medications (RXNorm)
Demographics
Lab Data
Other
Other notes for approved study or special considerations for configurations:
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