ClinCard Request Form
CTO kindly encourages the study team to submit 3-4 business days prior to the date of the study visit to ensure timely setup and ClinCards mailing.
CTO will review your request within 5 business days.
For urgent request, please select "Yes" to request expedite review. CTO might request the study team to fill out additional form for urgent review.
ClinCard Training Resources:
Systems for Sponsored Programs | Boston Medical Center (bmc.org)
Please click on Systems, ClinCard then Getting Started
Step 1: Select your study type and follow the appropriate instructions
New Study: My study has never been setup on ClinCard website
Existing Study: My study has been setup on ClinCard website
Requester Contact Information
Name:
Email:
INSTRUCTIONS FOR NEW STUDY SETUP
Please refer to the checklist below:
1.
Clincard Study Setup Request Form
Please provide the posting project number and cost center.
Department admin or fund/grant manager usually has this information
2.
Informed Consent Form (ICF)
IRB must have been approved
3.
Full Study Budget
Please indicate in the budget which line item that shows participant stipends.
Payment to participants in the study budget must match with what listed in the ICF and Clincard Study Setup Request Form
4.
Clincard User Access Request Form
New user must complete required
Training and Quiz
Send the User Access Request Form to
RIS@bmc.org
and
CTO@bmc.org
INSTRUCTIONS FOR EXISTING STUDY SETUP
Please refer to the steps below:
1.
Select the type of requests
2.
Refer to your requests to provide appropriate documents
Request additional clincards:
No need additional documents
Update posting project number:
Provide new posting project number
Update user roles:
Upload the ClinCard New User Access Request Form
Increase the study budget on ClinCard:
Provide an updated study budget
Add additional payment milestones:
Provide the study budget and list the new payment milestones in the
Clincard Study Setup Request Form
ClinCard (card issues):
Provide a screenshot or a description of the issue
Study Information
BMC PI Name
IRB Protocol (if there is NO-IRB, provide posting project number)
Date of the first anticipated study visit:
# of Cards Requested: (Max of 40 at a time)
Do you request expedite review of the Card Pickup Request Form?
Yes
No
If "Yes", please specify the reason
Study Documents Submissions: New Study
ClinCard Study Setup Request Form
Clincard User Access Request Form
ClinCard Study Setup Request Form
Informed Consent Form
Full Project Budget (Please indicate or highlight the cell values in the Full Project Budget the budget line item for participants compensation or stipends)
New User: ClinCard User Access Request Form
New user: ClinCard Quiz
Additional file (please label the file name)
Study Information: Existing Study
BMC PI Name
IRB Protocol
Do you request expedite review of the Card Pickup Request Form?
Yes
No
If "Yes", please specify the reason:
Select your type of requests
Request additional ClinCards
Update posting project number
Update user roles
Update Principal Investigator
Increase the study budget on ClinCard
Add additional payment milestones
Clincard (card issues)
Additional ClinCards
# of Cards Requested: (Max of 40 at a time)
When do you need the ClinCards by? (Please not delivery might take 1-3 days depending on your delivery options):
Posting Project Number
Provide the
current
posting project number:
Provide the
new
posting project number:
Budget and Payment Milestones
ClinCard Study Setup Request Form
ClinCard Study Setup Request Form (
please list out the new additional payment milestones
)
Informed Consent Form (
please provide an updated ICF that includes the new additional payment milestones
)
Full Project Budget (Please indicate or highlight the cell values in the Full Project Budget the budget line item for participants compensation or stipends)
Additional file (please label the file name)
ClinCard (card issues)
Screenshot
Description of the issue (if possible, specify the card token number and participant information (first and last name)
Update User Roles
Name:
Email:
Select user role (you can only be either the Approver or the Study Coordinator in one study):
Approver
Study Coordinator
ClinCard Account Information
Does the user have a ClinCard account?
Yes
No
ClinCard Account Information
If select "No", please upload the
ClinCard User Access Request Form
If select "No", please upload the ClinCard Quiz
Update Principal Investigator
Name of the new PI:
Email:
ClinCard Account Information
Does the PI have a ClinCard account?
Yes
No
Select user role (you can only be either the Approver or the Study Coordinator in one study):
Approver
Study Coordinator
ClinCard Account Information
If select "No", please upload the
ClinCard User Access Request Form
If select "No", please upload the ClinCard Quiz
Delivery and In-person Pickup Information
Delivery Options
In-person pick up (only
Wednesday 11AM-3PM
)
Interoffice Mailing (for
on-campus
delivery)
FEDEX (for
off-campus
and
outside
of Boston delivery)
In-person Pickup Information
Pick-up address
:
960 Massachusetts Avenue, lobby
CTO Office is located on the
2nd floor
.
Direction:
If you come from BMC main campus, walk or drive pass McDonalds, then you will see a big sign of "960." There is parking lot in front of the building.
Name of the person picking up ClinCards:
Contact number:
Requested Pick up Time: (11AM-3PM):
Meet at 960 Massachusetts Avenue (lobby)
Delivery Address Information
Name
E-mail
Street Address (includes Unit # or Apartment #)
F
or on-campus mailing, please specify building name and office room number
City
State
Zip Code
Phone Number
Comments (if there is anything we should know, please write it here)
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