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Your Department's Letterhead January 5, 1998
Materials Permission Department Dear Sir or Madam: I would like permission to copy an illustration from one of your books for continued use in patient education materials. The illustration will be used for patients who have had hip surgery. Title: Material to be duplicated: Page 555 (Chapter 12, Figure 12-7) Type of Reproduction: This illustration with caption, will be reformatted for a paper handout. The illustration will be reproduced digitally for inclusion in the web site of the Office of Patient Education, University of Utah Hospitals and Clinics (www.med.utah.edu/pated). Mounting the material on the Patient Education Intranet affords wider access within University of Utah Hospitals and Clinics, and more efficient updating of collateral material. Number of copies: Copies of the handout will be made on a continuing basis. Use to be made of reproduced materials: The figure will be used in conjunction with other materials to help patients understand how to get up from a chair following hip surgery. Distribution: The material will be provided to patients on an "as needed" basis. Access to the handout will be provided as part of care given by University of Utah Hospitals and Clinics. No charge will be made for the material per se. A self-addressed envelope and copy of this letter for your files are enclosed for your convenience. Please let me know what conditions, if any, apply to this use. Sincerely,
Jane A. Rogers Permission Granted: (signature) __________________________ Date: __________________ Conditions, if any:
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