Research Non-Employee Partner Access

> The purpose of this application is to initiate the process for Fred Hutch employees to be onboarded as non-employee "Affiliate Staff" at Seattle Children's.


> This application is ONLY for non-employees working on or directly supporting clinical research.


> If you are not working in clinical research, please email researchhr@seattlechildrens.org for further instructions.


> If you have any questions about this application, please contact partneraccess@seattlechildrens.org.


Application Type*
Home Institution

Often referred to as "Badge ID" number


Preferred name if different from "Applicant First Name"

Please include initials in the following order: first initial, middle initial (if applicable), then last initial. For example if you name is Summer Smith please include the initials "SS" or if Summer Jr. Smith then "SJS".

Notice: Your initials will be displayed in the application status tracking dashboard that will be emailed to applicants submitting new applications and extension requests.


Please only provide work email ending in "@fredhutch.org"

Phone

Extension Request - Affiliate Staff Profile Update

Your extension request requires that you review your current profile and make updates as necessary. Partner Access will send this to the email provided above. Please email us if you have any questions: partneraccess@seattlechildrens.org Thank you!



Previously at Children's as a Non-Employee?*
Facilities and Network Access Type*

*On-site access includes network access.

Patient Contact*
Do you need Epic access?*
Seattle Children's OnCore Access*

Good Clinical Practice (GCP) training

Good Clinical Practice (GCP) training certification is required for all non-employee supporting research protocols.


Compliance is monitored by Seattle Children's Office of Research Compliance (ORC).


Please review the Policy List:

https://www.cancerconsortium.org/research-support/clinical-research-support/policies.html


>CITI Program course training must be renewed every 3 years

Humans Subjects Protections (HSP) training

Human Subject Protection (HSP) training certification is required for all non-employee supporting research protocols.


Compliance is monitored by Seattle Children's Office of Research Compliance (ORC).


Please review the Policy List: https://www.cancerconsortium.org/research-support/clinical-research-support/policies.html


>CITI Program course training must be renewed every 3 years

Please upload your GCP and HSP Certification.

Incomplete applications may take longer to process.

Drag and drop files here or

Please complete the following for EACH role/study you will be working on.

Role/Study Portfolio

The main purpose of this form is to match Affiliate Staff profiles to research studies to comply with Seattle Children's patient Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA).


#1 Role/ Study Portfolio

(#1) Specific Role

Note - Faculty/ PI's will have a separate onboarding process that will be announced Spring 2022

(#1) Seattle Children's - Click IRB Status

FORMAT: STUDY00000000

Please provide the full or "long title"

Please provide the abbreviated study title

(#1) IRB of Record

Note - do not list sponsor name (example "NIH" or "PI Name")

FORMAT: FH00000 Also previously known as the IR File

FORMAT: RG0000000

If date unknown, please leave blank


Select all that apply. This will generate the same series of questions for each study/role.


#2 Role/ Study Portfolio

(#2) Specific Role
(#2) Seattle Children's - Click IRB Status
Select or enter value
Caret IconCaret symbol


#3 Role/ Study Portfolio

(#3) Specific Role
Select or enter value
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol
Select or enter value
Caret IconCaret symbol


#4 Role/ Study Portfolio

(#4) Specific Role
(#4) Seattle Children's - Click IRB Status

FORMAT: STUDY00000000

Please provide the full or "long title"

Please provide the abbreviated study title

Select or enter value
Caret IconCaret symbol

Note - do not list sponsor name (example "NIH" or "PI Name")

FORMAT: FH00000 Also previously known as the IR File

FORMAT: RG0000000

If date unknown, please leave blank


#5 Role/ Study Portfolio

(#5) Specific Role
(#5) Seattle Children's - Click IRB Status
(#5) IRB of Record


Fred Hutch Employee Attestation

Please review the information provided. Based on the applicants role at Fred Hutch, the applicant is qualified and authorized to access the protected health information of Seattle Children's patients in order to carry out their duties and responsibilities as a Fred Hutch employee or contractor.