Scott Triggers PLLC Copyright permission Revised 01-06-2022
Requesting Permission to use Copyrighted Material
Name of Company/Medical Center_____________________
State, Zip ________________________________________ Country____________
Email and website_______________________________
I am writing to ask your permission to utilize the Scott Triggers copyrighted tool (attached) for the following: (check all that apply)
_____ reprint _____ photocopy ______Publication (No charge)
_____ Digitize and incorporate into electronic medical records (EMR). (Annual Fee applies for EMR integration up to 5 locations/hospitals in the same company). If more than 5 hospitals please contact Susan Scott at firstname.lastname@example.org for a quote.
$1,000 annual fee payable to Susan M. Scott includes copyrighted tool integration into EMR such as EPIC, Cerner, MEDITECH, McKESSON, Allscripts, eClinicalWorks, NextGen, Athenahealth Healthland, Medsphere, QuadraMed, Sigmund, or others.
Included in the annual fee is the Scott Triggers® Solution resources and one hour of complimentary consulting time per online media for the purpose of strategic planning, and education. Three-year contracts available for 5% discount.
I have the authority to grant the permission requested herein and I hereby grant
______________________________________________________________________permission to use the above referenced material in the manner described.
Susan M. Scott, CEO Scott Triggers PLLC
Copyright Holder's Signature Date_______________ Expiration Date_______
I request that the credit line read: Scott Triggers® Reprinted with permission Susan M. Scott