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<title>Macomb Hospital-Warren Library Article Request, Henry Ford Hospital, Detroit, MI</title>
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<body bgcolor="224A73" leftmargin="0" topmargin="0" marginwidth="0" marginheight="0"><!--~ Dynamic website caching for reduced server load and increased crawlability. --><!-- links to cached pages --><noscript><table width="100%" border="0" cellspacing="0" cellpadding="0"><tr><td align="right"><a href="http://www.henryfordhealth.org/125157.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/152378.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/19438.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/19147.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/1.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/101.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a><a href="http://www.henryfordhealth.org/19085.cfm"><img src="http://www.henryfordhealth.org/HenryFordHealthSystem3.GIF" border="0"></a></td></tr></table></noscript><!-- B henryfordhealth.org ~--><!-- body ok -->
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		<td style="border-collapse:collapse;margin:0;padding:0;vertical-align:top;"><a href="http://www.henryford.com/"><img src="images/2008/logo_clear_body.gif" border="0" alt="Henry Ford Health System"></a></td>
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background=""><a href="body.cfm?id=47742"  class="">Volunteering</a></td>	</tr></table>
	
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						<span class="pageName"><h1>Macomb Hospital-Warren Library Article Request</h1></span>
						
							
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				<td class="metadetail" colspan="2">If you have any problems with this form, please send an email to <a href="mailto:sladenwebmaster@hfhs.org">Sladen Webmaster</a>.<br><br></td>
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				* Indicates required information</span></td>
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						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_1_2";
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					<nobr><input type="radio" name="eformField_1" id="eformField_1_3" style="{border:0;}" value="Interdepartmental Mail" onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_1_3" class="metadetail">Interdepartmental Mail</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_1_3";
						//--></script>
					<nobr><input type="radio" name="eformField_1" id="eformField_1_4" style="{border:0;}" value="Fax" onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_1_4" class="metadetail">Fax</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_1_4";
						//--></script>
					<nobr><input type="radio" name="eformField_1" id="eformField_1_5" style="{border:0;}" value="U.S. Mail (Specify Address below)" onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_1_5" class="metadetail">U.S. Mail (Specify Address below)</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_1_5";
						//--></script>
					<nobr><input type="radio" name="eformField_1" id="eformField_1_other" style="{border:0;}" value='Other' onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_1_other" class="metadetail">Other</label></nobr><br>
					<div class="metanew">
						<p class="metanew">
							If Other, please specify:<br>
							<textarea cols="30" rows="3" wrap="soft" name="eformField_1_other_txt" id="eformField_1_other_" disabled class="metadetail"></textarea>
						</p>
					</div>
					<script language="JavaScript" type="text/javascript"><!--
					smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_1_other";
					//--></script>
					<input type="hidden" name="eformField_1_other_txt_required" value='Please provide further details to your answer: Other.' disabled>
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Name&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_2" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_2_required" class="metadetail" value="Name is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Job Classification&nbsp;</th>
				<td class="metadetail">
					<select name="eformField_3" id="eformField_3" class="metadetail">
						<option value=""></option>
						<option value="Management Staff" selected>Management Staff</option>
						<option value="Staff Physician">Staff Physician</option>
						<option value="Intern/Resident/Fellow">Intern/Resident/Fellow</option>
						<option value="Medical Student/Extern">Medical Student/Extern</option>
						<option value="Nursing Staff">Nursing Staff</option>
						<option value="Clinical Support Staff">Clinical Support Staff</option>
						<option value="Non-Clinical Support Staff">Non-Clinical Support Staff</option>
						<option value="Patient/Consumer">Patient/Consumer</option>
						<option value="Other">Other</option>
					</select>
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Department&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_4" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Telephone/Beeper&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_5" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_5_required" class="metadetail" value="Telephone/Beeper is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Email Address&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_6" class="metadetail" size="35" value="">
					  
					<input type="Hidden" name="eformField_6_email" class="metadetail" value="Email Address must be a valid email address.">
					<input type="Hidden" name="eformField_6_required" class="metadetail" value="Email Address is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Fax Number&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_7" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail" colspan="2" style="{text-align:center;}">Fill in as much information as possible.  If you are not sure where the information goes, please click on Special Instructions and type all the information exactly as you see it.&nbsp;</th>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Unique Identifier (available on Medline printout):&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_9" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Author:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_10" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Article Title:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_11" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Journal Title:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_12" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Volume:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_13" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Issue:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_14" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Supplement:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_15" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Pages:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_16" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Year:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_17" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Special Instructions:&nbsp;</th>
				<td class="metadetail">
					<textarea name="eformField_18" class="metadetail" cols="40" rows="5"></textarea>
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail" colspan="2" style="{text-align:center;}">More Requests - Use the BACK button in your browser to return to the Article Request Form and fill out another request.  You will not have to re-type your personal information; just change the information in the affected fields (author, title, etc.)&nbsp;</th>
			</tr>
			<tr class="metadetail">
				<th class="metadetail">&nbsp;</td>
				<td class="metadetail">
					<input type="submit" name="submit" value="Submit" class="metadetail">
				</td>
			</tr>
		</table>
		</form>
	
	
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	<br>1-800-HENRYFORD (800-436-7936)&nbsp;&nbsp;&nbsp;&nbsp;Copyright 1997 - 2010</td>
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