ACTRI Clinic Access Request Form Logo
  • Requirements for Access to the ACTRI Clinic for New Users

    To ensure that all new ACTRI clinic users are well-acclimated to our workflows, mandatory orientations are required before access is granted. These trainings cover:

    • Clinical Conductor (Scheduling)
    • ACTRI Front Desk Procedures
    • ACTRI Nursing Staff Processes
    • ACTRI Coordinator Responsibilities

    The total estimated training time is approximately 8 hours, which may be divided into multiple sessions depending on your role and availability.

     
    1. ACTRI Front Desk & Nursing Staff

    • Orientations are held Tuesday through Thursday, with sessions available at 8:00 AM and 12:00 PM.
    • Sessions begin at the front desk and continue with the clinic nurses.
    • Please allow up to 3 hours for completion.
    • A member of the ACTRI Nursing team will contact you to schedule based on your availability.

    2. Clinical Conductor (Scheduling)

    • Training is held Thursdays at 2:30 PM.
    • David Marrufo will reach out to coordinate this session with you.

    3. ACTRI Coordinator

    • Availability for this training varies.
    • A member of the ACTRI CRC team will contact you to coordinate scheduling.

    To initiate the onboarding process, please submit the form below. Access will only be granted after all three trainings are completed, unless an exception has been approved.

    If you have any questions or need assistance, feel free to contact us at CTRI-Clinic@health.ucsd.edu.

  • Please do not continue if you are attempting to complete this request form for someone else.  The request form is created in a way where each response is specific to an individual.  Instead, we recommend that you forward the link below to the person who needs access and have them complete it for themself. 

     

    https://ucsd-actri.jotform.com/211674870051857 

     

    Please contact ctri-clinic@health.ucsd.edu for any questions regarding the form. 

    • -- General Section 
    • -- Clinic Badge Access Section 
    • Clinic Badge/Clinical Conductor Access:

      Complete the CITI Good Clinical Practice (GPC) course here CITI Program

      Your organization is: University of California, San Diego

      Additional Reading: Good Clinical Practices (GCP) Training Requirements

      Certificate Example: https://ucsdcloud-my.sharepoint.com/:b:/g/personal/mgaytan_ucsd_edu/EfPy3AQDwvZAhkPqnaAPqroB2bOIaasSeq7kHPiNtTD9ZQ?e=4xdd4g 

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    •  - -
    • Note:

      A Biomedical Research certificate is not required and cannot be used in lieu of the CITI "GCP" Certificate.

      We require the completion certificate and not the score reference guide in order to grant clinic access.

    • -- Clinical Lab Access Section 
    • Clinic Lab Access: 

      Complete the following three courses here UC Learning Center :

      1. Biosafety: Bloodborne Pathogens Training and Annual Refresher
      2. Annual Laboratory Hazards Training
      3. UC Laboratory Safety Fundamentals 

      Example Certificates: https://ucsdcloud-my.sharepoint.com/:f:/g/personal/mgaytan_ucsd_edu/EjlUBdjoavpFihm2skWdBp8BynDBLBK9fGIpRJN43ZWZ0w?e=y9iyCQ 

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    •  - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    •  - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    •  - -
    • -- Shipping Authorization Section 
    • Shipping Authorization: 

      Complete the following course here UC Learning Center. You must also complete all courses necessary for Clinic and Lab access. 

      1. Shipping Biological Substances and Dry Ice   

      Certificate Example: https://ucsdcloud-my.sharepoint.com/:b:/g/personal/mgaytan_ucsd_edu/ES_HhjC6ZVZFpNYiUenaf1AB7Z91u5HLDoNnlEoi2oFf8g?e=zkdSwm 

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    •  - -
    • Note:

      Shipping Authorization is not required, but if completed please submit a copy of the certificate.

    • -- Submit Section 
    • Should be Empty: