The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

poYIyQ6xuQbnjQbJCmyRGpAzyeskpes7rpG9f8WSxZ7Aurf4vdKLnETcnrowREEa6YLiXkYvwfbchj8N5mZ6ZzKBnR

IU Office of Clinical Research CDA Submission

This questionnaire must be completed by an IU or IU Health employee for all IU and IU Health CDA submissions. Questions may be addressed to ocr@iu.edu.

First Name

* must provide value

Last Name

* must provide value

E-mail

* must provide value

Sponsor \ CRO Name:

* must provide value

Sponsor Contact's Full Name:

* must provide value

Sponsor Contact's E-mail:

* must provide value

Sponsor Contact's Phone:

* must provide value

Do you have a Sponsor provided draft CDA?

* must provide value

Yes

reset

Upload CDA Draft

* must provide value

Upload file

Use IU CDA Draft Template?

* must provide value

Yes

reset

CDA DRAFT ISSUE!

You MUST upload CDA Draft or use IU CDA Draft template.

* must provide value

Study Identifier

* must provide value

Principal Investigator's Full Name

* must provide value

Principal Investigator's Dept

* must provide value

Principal Investigator's Email

* must provide value

Additional Notes / Comments

Expand

M-D-Y H:M

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.