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:

pI7oIYCYPxUU3CqpFnoEHuKhw5kZveRgN6kfr52PNXSSCykEkCNuAQ94DLR3GXF3IXi7ZvaYLLFXCajxPPpwvAWAKZGFPaBjwdmButFpdJ59RVf6hkkKzT4ou

REDCap User Account Application and End-User Agreement

Please complete the REDCap User Account Application and End-User Agreement form below.

Thank you!

What is your name?
(first and last name)

First Name

* must provide value

Last Name

* must provide value

What is your e-mail address?

Note: Please provide a UT Southwestern, PHHS, CMC or other university affiliate e-mail address. We cannot link REDCap accounts to personal e-mail addresses.

* must provide value

What is your Southwestern ID?

Note: Please provide a UT Southwestern, PHHS, CMC or other university affiliated e-mail user ID.

* must provide value

What is your work phone number?
Format: xxx-xxx-xxxx

What is your organization affiliation?

* must provide value

Are you (or your research group) a CTSA member?

To learn more about CTSA click here

* must provide value

Yes

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Have you attended any REDCap Training?
(weekly office hours held by the REDCap team)

* must provide value

Yes

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What type of project are you doing?

IRB Approved

IRB Exempt

UT Southwestern Business Need

Other Project by UT Southwestern Faculty

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Who is the UT Southwestern Faculty Sponsor of your project?
All REDCap projects must have a UT Southwestern Faculty member act as sponsor to the project.

* must provide value

If IRB approved

With PHI or PII

Without PHI or PII

REDCap Study Team will only be from UT Southwestern

REDCap Study Team will be both Internal and External to UT Southwestern

If IRB exempt

With PHI or PII

Without PHI or PII

REDCap Study Team will only be from UT Southwestern

REDCap Study Team will be both Internal and External to UT Southwestern

If UT Southwestern Business Need

Education

Administration or Operational

Health System

Public Health Surveillance

If other project done by UT Southwestern faculty

With PHI or PII

Without PHI or PII

REDCap Study Team will only be from UT Southwestern

REDCap Study Team will be both Internal and External to UT Southwestern

Your account should not be used by, or reassigned to anyone else.
By submitting this REDCap user account application, you verify that you will adhere to the following requirements:

* To disclose, receive, transmit, maintain or create data consistent with the electronic data collection policies of UT Southwestern and the State of Texas.

* To disclose personal information or private health information (PHI) only to those individuals who have a need to know such information in performance of their work and who have been trained according to the guidelines set by UT Southwestern or as otherwise required by law.

* If the project involves human subjects research, it has been submitted to the Institutional Review Board (IRB) for review or exemption and has been APPROVED before the project will be moved to production.

* The user understands that once a study is completed and all publications are finalized that their data may be de-identified and moved into the clinical research data warehouse for re-use if requested by the PI.

* The user understands that RAS staff will perform an audit prior to moving projects to production and will be responsible for:
-- Adding all new users to REDCap and assigning access rights and data access groups.
-- Approving and implementing any changes to project production forms.
-- Verifying use of valid common data elements (CDEs) for data reuse.

Violation of requirements will result in termination of user access. Reinstatement will be at the discretion of REDCap system administrators.

Use of an Electronic Data Capture (EDC) system in clinical research is governed by federal regulations and guidelines (21 CFR 312.62, 21 CFR 11, ICH GCP Guidance).

Do you agree to the terms above?

Yes

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Please enter your name here as an e-signature signing that you have read and agree to the End-User Agreement.

* must provide value

You have selected an option that triggers this survey to end right now.

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.