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eSafety Checklist Request
Thank you for requesting the eSafety Checklist. Please complete the information below in order to receive a copy by email.
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First and Last Name *
Institution Name *
Email *
How do you intend to use the checklist? *
Upon use, are you willing to share your results/findings with us so we can continue to improve the checklist? *
I agree that to use the eSafety Checklist I will cite the primary source in the Journal of Applied Clinical Informatics. *
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