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:

PJ9tc7cZRe9WcQeQaVSzkzkxmZCxiFTpLj3irYPHejugxtG72TS6spy2dRTNPiePryrQhSuoEQhKbn9gqHbktoUtti9gNAkMujiNhahv7wD53EywFDJNrSiRpFUrZ

MRN Request Form

Instructions: Complete this form to request an MRN (a medical record number) for your subject who is currently NOT an Emory Healthcare patient.

The Office for Clinical Research (OCR) will receive this request and generate an MRN for you. An email notification will be sent to notify the study team once it is created.

Before submitting this form:

1. Verify that the subject is not in Epic if you have access to the system.

2. If the subject is in Epic, an ADT Refresh can be completed in Epic to resend the subject to OnCore by clicking the "Resend Msg" in Epic.

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.