Name:

Date Requested: Date Needed:

Dept/Affiliation:     Select: Faculty Student Intern/Resident Staff MisHIN Non-UMC

Phone:    Fax No.

E-Mail Address:

For NON-UMC:

Mailing Address (must be completed for billing):

Years:

LIMITS:

English Only:      All Languages:      OTHER (Specify):

 

ADDITIONAL LIMITS:

Animal:	or Human:	or Both:
Male:	or Female:	or Both:

 

LIMIT AGE GROUPS:

ALL AGE GROUPS:	Infant, Newborn:	Infant (1-23 Months):
Child, Preschool (2-5 yrs):	Adolescence (12-18 yrs):	Adult (19-44 yrs):
Middle Age (45-65 yrs):	Aged (65+ yrs):	Aged (80+ yrs):

 

PURPOSE OF SEARCH:

Direct Patient Care:      Research:

 

INSTRUCTIONS:

Print abstracts:     Pick up in Library     FAX to patron:    E-Mail to Patron