ACTRI Study In-Service Request Form

ACTRI Study In-Service Request Form

***Due to high volume of requests for new study start-up, please plan for a 2-Month lead time ahead of when you anticipate to start recruiting, but after you have confirmation that your study will launch (IRB approved, budget approved, contract complete, etc). *All in-services will be conducted in person at 3:00pm Monday/Friday.*
Have you completed the ACTRI Clinical Research Services Request Form?
If you are unsure, please search your email inbox for a confirmation email that has a "JF-CLR-" confirmation number.
If you have not received a confirmation email (JF-CLR-######), please complete the ACTRI Clinical Research Services Request Form before attempting to complete this JotForm.

https://ucsd-actri.jotform.com/200906276270048

Please contact ctri-clinic@health.ucsd.edu for any questions regarding the form.
Please confirm your ACTRI Clinical Research Services Request Form Number
JF-CLR-######
- IRB#
- PI Last Name
- Study Title
- Does your study involve any of the following types of investigational products:
- JF - Investigational Products
- Submitter Name
  
  First NameLast Name
- Submitter Email
  example@example.com
- Upload Completed ACTRI In-Service Checklist
  
  Browse Files
  Template available on Clinic OneDrive Cancelof
- Upload Draft ACTRI Nursing Orders
  
  Browse Files
  Template available on Clinic OneDrive Cancelof
- Upload IRB Research Plan/Protocol
  
  Browse Files
  
  Cancelof
- Upload Informed Consent Form
  
  Browse Files
  
  Cancelof
- Please Provide the following Chart String information: Project, Task, Expenditure Organization, and Funding Source
- Has SIV Occurred?
- Scheduled SIV date
  
  MonthDayYear
  Date
- SIV Response
- Should be Empty: