Maryland State Anatomy Board
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Add New Pending Request
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Approved Request Details:
SR Details
SR Change Data
SR Cancel/Postpone
SR Branch Requests
SR Body Usage
SR Charges
SR Doctor Sign Off
SR Print Outs
Comments
Date of Request:
AM (8:30am-12:30pm)
PM (12:30pm-4:30pm)
Extended Hours:
Personal Information
Requester Name:
Requester Email:
Requester Phone:
Requester Address:
Requester City:
Requester ZipCode:
Requester State:
Study Details:
Amount of Tables/Number of Specimen:
Bodies Condition:
Disinfected
Embalmed
Non-disinfected
Donor Criteria (Specify):
Number of Participants:
Organization Information
Organization Name:
Organization Address:
Organization City:
Organization ZipCode:
Administrative Contact Name (if other):
Administrative Contact Email (if other):
Administrative Contact Phone (if other):
SAB Provided PPE
Study Provided PPE
Procedures Being Performed (List):
Special Requests (Describe)
Invoice Information
Invoice Contact Name:
Invoice Contact Phone:
Invoice Contact Email:
Invoice Contact Address:
Invoice Contact City:
Invoice Contact State:
Invoice Contact ZipCode:
Invoice Reference:
Invoice Tax Number:
SR Details
SR Change Data
SR Cancel/Postpone
SR Branch Requests
SR Body Usage
SR Charges
SR Transporter Release
SR Transporter Return
SR Print Outs
Comments
Date of Request:
Date of Pick-up:
Person Picking Up:
Date of Return:
Person Returning:
Personal Information
Requester Name:
Requester Email:
Requester Phone:
Requester Address:
Requester City:
Requester ZipCode:
Requester State:
Study Details:
Specimen Prep:
Disinfected
Embalmed
Specimen Type:
Cadaver Surgical
Cadaver Clinical
Upper Torso
Lower Torso
Upper Extremity
Lower Extremity
Full Spine
Head/Neck
Brain
Minimum
Other
Number of Specimen:
Any Donor Criteria (Specify):
Organization Information
Organization Name:
Organization Address:
Organization City:
Organization ZipCode:
Administrative Contact Name (if other):
Administrative Contact Email (if other):
Administrative Contact Phone (if other):
Procedures Being Performed (List):
Special Requests (Describe)
Invoice Information
Invoice Contact Name:
Invoice Contact Phone:
Invoice Contact Email:
Invoice Contact Address:
Invoice Contact City:
Invoice Contact State:
Invoice Contact ZipCode:
Invoice Reference:
Invoice Tax Number:
