---
title: Clinical Trial Patient Eligibility Data Access Request Form Template | Paperform
description: Secure form template for requesting access to clinical trial patient data, including eligibility records, medical history, enrollment status, and travel reimbursements. HIPAA-ready and compliance-focused.
url: "https://paperform.co/templates/clinical-trial-patient-eligibility-data-access-request-form"
type: static
generatedAt: "2026-03-28T00:43:20.948Z"
---

[← Back to free form templates](/templates/)    ![Clinical Trial Patient Eligibility Data Access Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/clinical-trial-patient-eligibility-data-access-request-form.png)
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### Streamline Clinical Trial Data Access with Paperform

When you're managing clinical trials, accessing patient eligibility data, medical history screenings, and enrollment records needs to be both secure and efficient. This **Clinical Trial Patient Eligibility Data Access Request Form** template helps research institutions, pharmaceutical companies, and healthcare organizations manage data access permissions while maintaining strict compliance and audit trails.

#### Why clinical trial data access requests matter

Clinical trials generate vast amounts of sensitive patient data—from initial eligibility screenings and medical histories to enrollment status and travel reimbursement records. Research coordinators, data analysts, principal investigators, and compliance officers all need timely access to this information, but every request must be properly documented, justified, and approved to protect patient privacy and meet regulatory requirements.

A well-structured data access request form ensures that only authorized personnel can access sensitive trial data, creates a clear audit trail for compliance reviews, and streamlines the approval workflow so research can proceed without unnecessary delays.

#### Who should use this template

This form template is designed for:

 - **Clinical research organizations (CROs)** managing multi-site trials
 - **Pharmaceutical and biotech companies** conducting patient recruitment and enrollment
 - **Academic medical centers** running investigator-initiated studies
 - **Hospital research departments** coordinating trial participation
 - **Data management teams** overseeing trial databases and electronic health records
 - **Regulatory affairs professionals** ensuring compliance with FDA, EMA, and IRB requirements

Whether you're a research coordinator processing data requests, an IT administrator managing database permissions, or a compliance officer maintaining audit documentation, this template provides the structure you need.

#### What makes this template effective

This clinical trial data access request form captures all the essential information required for proper authorization:

 - **Requestor details and credentials** to verify identity and role
 - **Specific data types requested** (eligibility records, medical history, enrollment status, reimbursements)
 - **Trial-specific information** to scope access appropriately
 - **Purpose and justification** for the data access request
 - **Time-bound access parameters** to limit exposure
 - **Supervisor approval fields** for proper authorization workflow
 - **Compliance acknowledgments** for HIPAA, GCP, and institutional policies

The form uses conditional logic to show relevant fields based on the type of data being requested, ensuring requestors only see questions applicable to their specific needs.

#### Automate your clinical trial workflows with Paperform and Stepper

While this form captures data access requests efficiently, Paperform's integration with **[Stepper](https://stepper.io)** can transform it into a complete approval and provisioning workflow:

 - Automatically route requests to appropriate approvers based on data sensitivity level
 - Trigger notifications to IT teams once requests are approved to provision database access
 - Create audit logs in your compliance management system for every data access event
 - Update access control lists in your trial management system (CTMS) automatically
 - Send time-based reminders to revoke access when the approved period expires
 - Generate compliance reports summarizing all data access requests by trial, role, or department

This automation eliminates manual handoffs, reduces approval times from days to hours, and ensures your organization maintains continuous compliance with data governance policies.

#### Security and compliance you can trust

Clinical trial data is among the most sensitive information healthcare organizations manage. Paperform is **SOC 2 Type II compliant** and offers data residency controls, giving you confidence that your data access request forms meet the security standards required for regulated research environments.

All form submissions are encrypted in transit and at rest, role-based permissions ensure only authorized team members can view request data, and detailed audit trails track every form submission and approval action for regulatory inspections.

#### Integrate with your existing research infrastructure

This template works seamlessly with the tools clinical research teams already use:

 - **CTMS platforms** (Medidata, Veeva, Oracle Siebel) to log access requests
 - **Electronic data capture (EDC) systems** to cross-reference trial and patient data
 - **Identity management systems** to verify requestor credentials
 - **Compliance management tools** to maintain audit documentation
 - **Slack or Microsoft Teams** for real-time approval notifications
 - **Google Sheets or Airtable** for tracking all pending and completed requests

Whether you're a small research site or a global CRO managing dozens of concurrent trials, this form template adapts to your scale and integrates into your existing workflows without requiring IT resources or custom development.

#### Get started in minutes

With Paperform's doc-style editor, you can customize this template to match your organization's specific data governance policies, add your institutional branding, and deploy it to your research teams in minutes—no coding required. Conditional logic, calculation fields, and approval workflows that might take weeks to build in custom database forms are ready to use out of the box.

Start streamlining your clinical trial data access requests today with Paperform, and spend less time on administrative paperwork and more time advancing medical research.
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