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<title>Request to Purchase Materials-Macomb Hospital-Wa, 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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href="body_nologin.cfm?id=39330"  class="">Patient Library</a></td>	</tr>	<tr class=""  background="">		<td class="" colspan="2" valign="middle" align="left" background="" title=""><img src="images/2008/leftnavspacer.gif"></td>	</tr>	<tr  background="">		<td class=""   valign="middle" align="left" background="" title="">&nbsp;<img src="images/2008/left_arrow.gif" border=0 alt="Podcasts" id="Nav_Bullet_5_9" name="Nav_Bullet_5_9">&nbsp;</td>		<td class="" valign="middle" align="left" background=""><a href="body.cfm?id=48646"  class="">Podcasts</a></td>	</tr>	<tr class=""  background="">		<td class="" colspan="2" valign="middle" align="left" background="" title=""><img src="images/2008/leftnavspacer.gif"></td>	</tr>	<tr  background="">		<td class=""   valign="middle" align="left" background="" title="">&nbsp;<img src="images/2008/left_arrow.gif" border=0 alt="Pricing" id="Nav_Bullet_5_10" name="Nav_Bullet_5_10">&nbsp;</td>		<td class="" valign="middle" align="left" 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						<span class="pageName"><h1>Request to Purchase Materials-Macomb Hospital-Wa</h1></span>
						
							
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		<form name="eform" method="post" action="http://www.henryford.com/body_nologin.cfm?xyzpdqabc=0&id=52441&amp;action=submiteform" onSubmit="return (sm_ValidateForm(this) && sm_removeALLrequiredhiddenfields(this));" class="metadetail">
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				<td class="metadetail" colspan="2">We welcome your suggestions for books, journals and electronic resources, and try to incorporate as many as possible.&nbsp;&nbsp;Your suggestions help us build a collection of resources that's right for your information needs.<br><br>Please fill in as much information as possible.&nbsp;&nbsp;For book suggestions, we will notify you of our decision in approximately one week.&nbsp;&nbsp;For journal suggestions, we will notify you of our decision in December as we add new titles on an annual basis.<br><br>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">What Type of Material?&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<nobr><input type="radio" name="eformField_1" id="eformField_1_1" style="{border:0;}" value="Book" checked>
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					<label for="eformField_1_2" class="metadetail">Journal</label></nobr><br>
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				<th valign="top" class="metadetail">Title of the Book or Journal:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_2" class="metadetail" size="35" value="">
				</td>
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				<th valign="top" class="metadetail">Editor(s) or Author(s):&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_3" class="metadetail" size="35" value="">
				</td>
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				<th valign="top" class="metadetail">Year of Publication:&nbsp;</th>
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				</td>
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				<th valign="top" class="metadetail">Publisher:&nbsp;</th>
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				</td>
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				<th valign="top" class="metadetail">ISSN or ISBN:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_6" class="metadetail" size="35" value="">
				</td>
			</tr>
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				<th valign="top" class="metadetail">Your Name:&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_7" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_7_required" class="metadetail" value="Your Name: is required.">
				</td>
			</tr>
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				<th valign="top" class="metadetail">Department:&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_8" class="metadetail" size="35" value="">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Phone/Beeper:&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_9" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_9_required" class="metadetail" value="Phone/Beeper: is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Email:&nbsp;<span class="required">*</span>&nbsp;</th>
				<td class="metadetail">
					<input type="Text" name="eformField_10" class="metadetail" size="35" value="">
					<input type="Hidden" name="eformField_10_required" class="metadetail" value="Email: is required.">
				</td>
			</tr>
			<tr class="metadetail">
				<th valign="top" class="metadetail">Do you want to be notified when the item arrives?&nbsp;<span class="required">*</span>&nbsp;</th>
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