MedHub Access Request

Name * Email *

Note: If employed or appointed by IUSM, this must be an IU account.

Phone Number * Department *

Position Title & Responsibilities *

Please provide a thorough description of role and responsibilities that require MedHub access.

Campus(es) * Bloomington Evansville Fort Wayne Gary Indianapolis Muncie South Bend Terre Haute West Lafayette Programs(s)/Course(s) *

Institution/Affiliate Organization

(if anything other than IUSM)

Completed the IU Acceptable Use Agreement.*

Required for all users with IU accounts. Please visit https://access.iu.edu/useragreement/hasagreement to verify. Yes

Completed the Data Protection and Privacy Tutorial.*

Required for all users with IU accounts. Please visit https://ferpa.iu.edu/ and click on the link for the Data Protection and Privacy Tutorial. Yes

Completed the FERPA Tutorial.*

Required for all users requesting access to MSE functionality within MedHub and/or who interact with medical students. Please visit https://ferpa.iu.edu/ and click on the link for the FERPA Tutorial. Yes No

MedHub Interface Access

What type of MedHub account(s) are required? MSE/UME (medical students, clerkships, etc.) GME (residents, fellows, programs, etc.) Combined MSE+GME access (students & residents/fellows) I'm not sure.

GME Access Permissions in MedHub

Please select all MedHub functionalities below that relate to specific responsibilities so we can determine the best type of account for that role. Scheduling Procedure Logging & Verification Evaluations Conferences Reports

MSE Role Type

Please select your role within MSE below so we can determine the best type of MedHub account permissions. Dean's Office Administrator Statewide Clerkship Coordinator Clerkship Admin Support Registrar PAE CAITS Business Intelligence

Contact for Verification: Name *

This should be a Director at IUSM, whether for a Clerkship, Course, GME Program, Regional Center, etc.

Contact for Verification: Email *

Please note: submitting this form will trigger an automated message to the Verification for Contact identified, requesting approval on your behalf. Contact for Verification: Phone Number *

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