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Siteman Database Access Request Instructions

Please complete the user information section.  Computer Location is where the computer you will most often be working from is at.  Network Domain is the computer domain you log into (i.e., WUDOSIS, DOM, etc.).  The user must provide a Network Domain.

This database is restricted to computers on the Washington University and Barnes-Jewish Hospital secure networks (wucon, carenet); other locations will require a private VPN account to access the system.  Access for volunteers, contractors or temporary employees will only be granted if an expiration date for the access is provided in the notes area.  The expiration date should be no more than one year after the date the request is submitted.

Protocol Writing- this access allows a user to enter protocol related data and post electronic documents to any trial where the user is designated as a principle investigator, study coordinator, or regulatory coordinator.  The users are able to review patient, enrollment and treatment information for trials they are associated with.  This is appropriate for users who serve in any of the roles listed for one or more cancer related clinical trials.

Protocol Reading allows a user to read protocol related data and electronic documents for any cancer related protocol.  This is appropriate for faculty and staff members of Washington University and Barnes-Jewish Hospital who require information about cancer related clinical trials.  Note this does not allow access to specific patient or enrollment information.

Please seek your manager's approval before submitting this request.

The user will be notified when the request has been completed.  Standard turn around time is 3 working days.  Questions about use of the database may be directed to the SCC Education Coordinator at 747-4536.

Conditions of Access

The Siteman Cancer Center database contains confidential information.  As a condition of accessing the database the user agrees to the following.

  1. The user will safeguard the username and password any username and password used to access the system.  This password should not be shared with be shared with anyone else.  If the user believes the database password has been compromised the user will contact SCC information systems at 362-4540.
  2. The user will only share information in the SCC database with individuals authorized to see it.
  3. The user will follow safe computing practices to protect the information in the database.  This includes logging off of the database when is no longer needed, locking the computer when it is unattended, etc.
  4. Some of the information in the database is personnel healthcare information (PHI) that is protected by HIPAA.  Any users accessing PHI must receive HIPAA training and agree to comply with all HIPAA regulation when using the SCC database.

By signing this agreement the user accepts all of the conditions of access above and acknowledges that any violation of these conditions may result in having access to the database revoked.


User Information

First Name:
Last Name:
Computer Location:
Network Domain:
Domain Username:
Person's Account to Mirror:
Type of Request:
Access Request:
  * - Users can write information to cancer related protocol(s)
they are associated with. See instructions.
** - Users can read protocol related data and electronic
documents for cancer related protocol(s). See instructions. 

Notes:Please note if the new user will replace a former/ current employee or the name of a current employee whose access should be mirrored. If access is for a new position or does not replace a former employee, provide information about how the user plans to use the database (i.e. willenter IRB dates/regulatory, register patients, only access protocols and consents).

Please seek your manager's approval before submitting this request.  
User's Signature:
Manager's Signature: