Please complete one form per item.
Title:
Author/Editor:
Publisher/Producer:
Format: Book Subscription Video CDROM Database
Justification (please explain how this will assist you in your work or be used in an educational program):
Please provide the following :
Name : Date:
Phone/Beeper: Email:
Shift: Days Afternoons Midnights Casual Position: None Physician Resident Intern Extern Nurse Management Other
Department:
Enter the text as it is shown in the above box: