Forms

Future Lab Visit Request Form

ARUP Electronic Exemption Request Form

Apply to Use CCTS Resources – CCTS Application

Protocol Billing Grid 

The official University of Utah Protocol Billing Grid (PBG) is now electronic – and interactive with the new EPIC clinical billing system.  A central feature ofUniversity Tracking of Clinical Research (uTRAC), the electronic management system required of all clinical research (CR) studies, the electronic PBG performs several crucial automations:  a single visit schedule that populates each participant’s study dates and events;  federally compliant CR pricing; comprehensive budgeting of all per-participant costs; application of required CR modifiers for billing to federal insurance; and routing of study billing for electronic payment.  The original PBG, accessible through the link above, is an Excel spreadsheet that study teams may  use for quick paper documentation. 

Signature Authorization Form  - ePay Approvers must be on study’s signature authorization form