UC Health Greenphire Request Form

Please complete the UC Health Greenphire Request Form below if you would like to start a new study, order ClinCards, or modify/close an existing study. This form is meant to be filled out for UC Health studies. If your study is grant funded through the University of Cincinnati: do not complete this form and reach out to GreenphireClinCard@ucmail.uc.edu

Note: all card transactions are final. Refunds are not offered for card orders.

Do not forget to review/download our Greenphire Resources. You can find useful information on how to use the system and how to set up your payments/reimbursements appropriately. Greenphire has also developed a ClinCard Training Video for new users.

Questions? Contact: UCH-Greenphire@UCHealth.com

Date of this request

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M-D-Y

Submitter name

* must provide value

Submitter email

* must provide value

What is the nature of this request?

* must provide value

Study short name

* must provide value

Study account number (T-number)

* must provide value

IRB number

* must provide value

Principal Investigator first name

* must provide value

Principal Investigator last name

* must provide value

Department

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Define other department

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If you are making a change to the payment schedule or study personnel, please download the Study Information Spreadsheet below and upload to this request.

Number of cards being requested

* must provide value

Using the document attached below, provide the payment structure and users for the study. Please make sure you complete both sheets of the excel file.

It is best practice to not have the same person be both a coordinator and approver.
Make sure taxation is taken into consideration when you complete the payments. If you have any questions about how disbursements are deemed taxable or non-taxable in Greenphire, reference this resource: Greenphire Tax Information.

Download and complete the attached document and upload to this request in the below field.

Attachment:Greenphire Study Information Spreadsheet.xlsx

Upload Greenphire study information spreadsheet

Upload file

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