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<title>Macomb Hospital-Warren Library Book 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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		<table  background="" border="0" cellspacing="0" cellpadding="0">	<tr class=""  background="">		<td class="" valign="middle" align="center" background="" title=""><a href="http://www.henryford.com"  class="">Home</a></td>		<td class="" valign="middle" align="center" background="" title=""><img src="images/2008/topnavline.gif"></td>		<td class="" valign="middle" align="center" background="" title=""><a href="body.cfm?id=48446"  class="">After Hours & Urgent Care</a></td>		<td class="" valign="middle" align="center" background="" title=""><img src="images/2008/topnavline.gif"></td>		<td class="" valign="middle" align="center" background="" title=""><a href="body.cfm?id=45404"  class="">Hospitals</a></td>		<td class="" valign="middle" align="center" background="" title=""><img src="images/2008/topnavline.gif"></td>		<td class="" valign="middle" align="center" background="" title=""><a href="body.cfm?id=37839"  class="">Medical Centers</a></td>		<td class="" valign="middle" align="center" background="" title=""><img src="images/2008/topnavline.gif"></td>		<td class="" valign="middle" align="center" background="" title=""><a href="body.cfm?id=40194"  class="">Emergency Rooms</a></td>		<td class="" valign="middle" align="center" background="" title=""><img src="images/2008/topnavline.gif"></td>		<td class="" valign="middle" align="center" background="" title=""><a href="body.cfm?id=38557"  class="">Pharmacies</a></td>	</tr></table>
	
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						<span class="pageName"><h1>Macomb Hospital-Warren Library Book 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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				<th valign="top" class="metadetail">Notification Options (How would you like the Library to notify you when your materials are ready?)&nbsp;<span class="required">*</span>&nbsp;</th>
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				<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;</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.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail" colspan="2" style="{text-align:center;}">Normal Turnaround Time is 5-10 days&nbsp;</th>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">What type of material are you requesting?&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<nobr><input type="radio" name="eformField_8" id="eformField_8_1" style="{border:0;}" value="Borrow this entire book" checked onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_8_1" class="metadetail">Borrow this entire book</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_8_1";
						//--></script>
					<nobr><input type="radio" name="eformField_8" id="eformField_8_2" style="{border:0;}" value="Photocopy this book chapter" onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_8_2" class="metadetail">Photocopy this book chapter</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_8_2";
						//--></script>
					<nobr><input type="radio" name="eformField_8" id="eformField_8_3" style="{border:0;}" value="Borrow this audiovisual" onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_8_3" class="metadetail">Borrow this audiovisual</label></nobr><br>
						<script language="JavaScript" type="text/javascript"><!--
						smm_eforms_toggle_other_to_init[smm_eforms_toggle_other_to_init.length] = "eformField_8_3";
						//--></script>
					<nobr><input type="radio" name="eformField_8" id="eformField_8_other" style="{border:0;}" value='Other' onClick="return smm_eforms_toggle_other(this);">
					<label for="eformField_8_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_8_other_txt" id="eformField_8_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_8_other";
					//--></script>
					<input type="hidden" name="eformField_8_other_txt_required" value='Please provide further details to your answer: Other.' disabled>
				</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 Miscellaneous and type all the information exactly as you see it.&nbsp;</th>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Authors/Editors:&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">Item 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">Chapter Authors:&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">Chapter Title:&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">Pages:&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">Publisher/Producer:&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">Place of Publication:&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">Series:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_18" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Edition:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_19" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">ISBN:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_20" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Format (Audiovisual):&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_21" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Miscellaneous:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_22" class="metadetail" size="35" value="">
				</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 Book 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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