Type of user
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SPARC Request User SPARC Request Service Provider/Administrator
Please select whether you are a User or Service Provider/Administrator
E-mail
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Today M-D-Y
Bug
Enhancement/Feature Request
Training
Other
Please explain what your request is about.
Bug
Enhancement/Feature Request
Training
Reports - Please upload sample report in documents section.
Other
Please explain what your request is about.
User Priority
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Immediate work stoppage
High
Normal
Low
Browser
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Internet Explorer Mozilla Firefox Google Chrome Safari
Which browser are you using?
Which version are you using?
SPARC Request ID/Request Name
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SPARC ID if relevant (ex:1234 or 1234-0000) or Request Identifier
Do you have a document to upload?
Yes
No
Upload up to 4 documents.
SPARC Application
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SPARC Request User Portal/Dashboard Administrative Portal Clinical Work Fulfillment Catalog Manager Epic Interface General
Which SPARC Application are you using?
SPARC Application
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SPARC Request User Portal/Dashboard Epic Interface General
Which SPARC Application are you using?
SPARC Request
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Requesting Services (Home Page) Step 1 Step 2A Step 2B Step 3 Step 4 Step 5 Other
Which step are you on in SPARC?
Requesting Services (Home Page)
Search Add Services Delete Services Ask a Question Feedback FAQ/Help Create an Account Missing Service
What part of the home page are you inquiring about?
Step 1 (Protocol Information)
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Create New Study Edit Existing Study Adding Users
Step 2A (Date and ARM Information)
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Please provide details about your request.
Step 2B (Visit Calendar/Billing Information)
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Template Tab Quantity Billing Tab
Which tab are you inquiring about?
Step 3 (Notes and Documents)
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Step 4 (Review Section)
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Step 5 (Confirmation Page)
Download Request User Portal Button
Which button are you inquiring about?
Other
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User Portal/Dashboard
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Search Create New Study Notifications Edit Study Information Edit Authorized Users Edit Service Requests Consolidated Requests Other
Which section of the User Portal are you on?
Search
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Please provide details about your request.
Create New Study
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Please provide details about your request.
Notifications
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Please provide details about your request.
Edit Study Information
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Please provide details about your request.
Edit Authorized Users
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Edit Service Requests
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Edit Edit Original
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Consolidated Request
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Other
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Administrative Portal
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Search Sort Reporting Export Send to Epic Fulfillment Project/Study Information Documents Related Service Request Associated Users Notifications Other
Which section of the Administrative Portal are you using?
Search
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Please provide details about your request.
Please provide details about your request.
Reporting
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Export
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Send to Epic
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Fulfillment
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Subsidy Add Arm Delete Arm Add Visit Delete Visit Add Service Delete Service Changing Services Study Day/Window
Project/Study Information
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Please provide details about your request.
Documents
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Please provide details about your request.
Related Service Requests
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Please provide details about your request.
Associated Users
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Please provide details about your request.
Notifications
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Please provide details about your request.
Other
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Please provide details about your request.
Clinical Work Fulfillment
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Search Sort Auditing/Billing Report Study Schedule Subject Tracker Payments Other
Which section of Clinical Work Fulfillment are you using?
Search
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Please provide details about your request.
Please provide details about your request.
Auditing/Billing Report
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Please provide details about your request.
Study Schedule
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Add Arm Delete Arm Add Visit Delete Visit Add Service Delete Service Changing Services Study Day/Window
Which section of the Study Schedule are you inquiring about?
Subject Tracker
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Entering/Adding Subjects Schedule Reporting
Which section of the Subject Tracker are you inquiring about?
Entering/Adding Subjects
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Please provide details about your request.
Schedule
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Dashboard Services Comments Saving Visits
Which part of the schedule are you inquiring about?
Services
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Selecting Visits Quantity/Billing Unit Cost Total Cost Add Service
Which sections of the services are you inquiring about?
Reporting
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Subject Level Report Research Project Summary Report
Which report are you inquiring about?
Subject Level Report
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Cannot Run Data Wrong Data Other
Which issue are you having with this report?
Research Project Summary Report
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Cannot Run Data Wrong Data Other
Which issue are you having with this report?
Payments
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Adding/Saving Payments Payments not Applied Other
Which issue are you having with payments?
Other
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Search Creating Institution Creating Provider Creating Program Creating Core Creating Service Other
Which section or Catalog Manager are you using?
Name CPT Code Charge Code
What part of the search are you inquiring about?
General Info User Rights Clinical Work Fulfillment
Which section of the institution are you inquiring about?
Order Description Acknowledgement Language Color Do Not Display Tags
Which section of general info are you inquiring about?
Super Users Catalog Managers
Which user rights are you inquiring about?
Clinical Work Fulfillment
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Show Clinical Provider Rights
What type of issue are you having with the CWF section?
General Info Status Options User Rights Pricing Surveys Clinical work fulfillment
Which section of the provider are you inquiring about?
Order Description Acknowledgement Language Color Split/Notify Do Not Display Tags
Which part of the general info are you inquiring about?
Status Options
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Please provide details about your request.
Super Users Catalog Managers Service Providers Submission Emails
Which section of the user rights are you inquiring about?
Automatic Pricing Adjustment Pricing Set Up Subsidy
Which section of the pricing are you inquiring about?
Surveys
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Please provide details about your request.
Clinical Work Fulfillment
Show Clinical Provider Rights
What part of CWF are you inquiring about?
General Info Status Options User Rights Pricing Surveys Clinical Work Fulfillment
Which part of the program are you inquiring about?
Order Description Acknowledgement Language Split/Notify Do Not Display Tags
Which section of general info are you inquiring about?
Status Options
* must provide value
Please provide details about your request.
Super Users Catalog Managers Service Providers Submission Emails
Which section of user rights are you inquiring about?
Automatic Pricing Adjustment Pricing Setup Subsidy
Which section of the pricing are you inquiring about?
Sureveys
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Please provide details about your request.
Clinical Work Fulfillment
Show Clinical Provider Rights
What part of CWF are you inquiring about?
General Info Status Options User Rights Pricing Survey Clinical Work Fulfillment
Which section of the core are you inquiring about?
Order Description Acknowledgment Language Split/Notify Do Not Display Tags
Which section of general info are you inquiring about?
Status Options
* must provide value
Please provide details about your request.
Super Users Catalog Managers Service Providers Submission Emails
Which section of user rights are you inquiring about?
Automatic Pricing Adjustment Subsidy Information
Which section of the pricing are you inquiring about?
Survey
* must provide value
Please provide details about your request.
Clinical Work Fulfillment
Show Clinical Provider Rights
What part of CWF are you inquiring about?
General Info Pricing Maps Related Services Other (CPT, CDM, etc.)
Which section of adding a service are you inquiring about?
Program/Core Order Description Do Not Display Tags
Which section of general info are you inquiring about?
Dates Rates Per Patient One Time Fee Save
Which section of the pricing maps are you inquiring about?
Required Optional Linked Quantity
Which part of related services are you inquiring about?
Other (CPT, CDM, etc.)
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Please provide details about your request.
Other
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Epic Interface
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Mass User Import Deleting Protocols Manually Enter
Please select the section you are inquiring about.
General
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