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colpitts clinical portal

PORTAL INSTRUCTIONS

INFORMATION
If you would like to keep records of your submission
Please print the forms before you submit. There is no way to go back to the forms once they are submitted due to HIPAA compliance.
What is a Per Diem?
A per diem is money preloaded to a patient’s reloadable VISA card for meals during their visit.
After a travel request is Submitted

You and the patient will get an email within 48 hours acknowledging there has been a request made. At a later time, depending on their travel dates, one of our travel coordinators will reach out directly to the patient to coordinate their travel. An itinerary will be sent to both you and the patient once travel has been booked.

NOTE: A Patient Profile does not prompt an acknowledgement email and does not take the place of a travel request. It simply establishes a patient in our system
Reloadable VISA Card (aka PEX Card)
Per diem funds and expense reimbursement funds are loaded to the same card – It is mailed to the patient directly – A patient will have 1 card for the whole trial that will be reloaded accordingly - Can be used wherever VISA is accepted - There is no cash access.
INSTRUCTIONS

**IMPORTANT**

  1. Refer to the Welcome Email you received from Colpitts for the services available for this study.

  2. Below is a list of all possible reservation and expense services that Colpitts offers. This study may not include all of them.
INSTRUCTIONS FOR ALL COLPITTS SERVICES
IF your patient needs Travel (air, rail, hotel or ground transportation)

Go to Travel Request (Link 2)
Fill in the applicable areas on the form and submit.

IF there are meal per diems available to subjects for this study the travel request will prompt Colpitts to send the patient a Reloadable VISA Card and load the funds to the card 2 business days prior to the travel dates. You do not need to fill out a separate form for the per diem
IF your patient ONLY needs Sedan Services (Car and Driver)

Go to Ground Transportation Only (Link 3)
Fill in the appropriate areas on the form and submit.

NOTE: This is not an on-demand service and must be prearranged up to 48 hours or more in advance. Taxi/Uber/Lyft and any other ride sharing services must be arranged and paid for by the patient.

IF there are meal per diems available to subjects for this study the travel request will prompt Colpitts to send the patient a Reloadable VISA Card and load the funds to the card 2 business days prior to the travel dates. You do not need to fill out a separate form for the per diem.

IF part of the travel guidelines, taxi/Uber/Lyft and public transportation can be reimbursed through the Patient Expense link (Link4) (see instructions on this below)
IF your patient does NOT need Travel Services, and ONLY needs Meal Per Diem

Go to Prepaid Card Only (Link 5).
Fill in the appropriate areas on the form and submit.

IF there is a caregiver accompanying the patient and the study guidelines allows for them to receive a per diem as well, you can put both on this form.
IF your patient needs to be reimbursed for study related, out-of-pocket, expenses

Go to Patient Expense (Link 4). 

Download a copy of the Expense Sheet and fill it out. Then fill out the online form, upload the Expense Sheet and all receipt copies, and submit.