Research Request Form Question Title * 1. Contact Information: Name: * Affiliation: * Specialty: * Email Address: * Phone Number: Question Title * 2. How urgent is your request? Not time sensitive Somewhat time sensitive Time sensitive Urgent patient care Urgency: Urgency: Not time sensitive Urgency: Somewhat time sensitive Urgency: Time sensitive Urgency: Urgent patient care Date Needed By: Question Title * 3. Clinical question (What information are you seeking?): Question Title * 4. Please select which type of request you need: Literature review Best practice inquiry Specific article request - list citation(s) in comment box below Other (please specify) Question Title * 5. Please select at least one of the following reasons for your request: Patient care improvement Policy update Best practice project College class assignment Presentation or lecture IDA or RCA (DOH/JC requirement) Personal study or interest Other (please specify) Question Title * 6. How do you want the articles delivered: PDFs e-mailed a attachments Link to PDFs (for saving or printing out as needed) Print/pick-up Question Title * 7. Comments / Citations: Done
