Permissions

Joint Commission Resources’ policy for photocopying or reuse of copyrighted material covers periodicals. No changes in, additions to, or deletions from the copied or reused text should be made without prior written approval of Joint Commission Resources. Permission applies only to the material specified in correspondence and for print copies only. New requests should be made for subsequent use or for other uses of material.

Organizations that want to make photocopies or reproduce material in another publication must request permission to do so. Written requests should be mailed or faxed to the Permissions Editor at Joint Commission Resources. Please use the form below when requesting permission.

Any organization may request permission to reproduce for educational or publication use
article(s) from Joint Commission Resources periodicals. Such permission may be granted with a fee at the discretion of the publisher.

Questions regarding this policy should be directed to the Permissions Editor in the Department of Publications at 630/792-5455, or via e-mail at permissions@jcrinc.com.

Please print and complete this form, and fax it to 630/792-4450. You will be contacted within 5 to 10 business days with a response to your request. For questions or concerns, please contact permissions@jcrinc.com, call 630/792-5450, or fax 630/792-4450.

*Note: Asterisk field(s) indicates mandatory fields


*Today's Date:________________________________

*Company Name: ________________________________________________________

*Accredited Organization (circle one): Yes..........No..........Does not apply

*Educational Institution (circle one): Yes..........No..........Does not apply

*Contact Name: __________________________________________________________

*Your Title: _______________________________________________________________

Department: _____________________________________________________________

*Telephone: (_____) ______-_________ Ext: ____________

*Fax Number: (_____) ______-_________

E-mail Address: _______________________________________

*Mailing Address:
________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

*City, State, Zip: ___________________________, _____ __________-________

Country (if outside of the USA): _______________________________________________


Please circle one.
Accreditation Manual..........Book..........Newsletter/Periodical..........Other

*Name of JCR product: ____________________________________________________

*Text Description: _________________________________________________________

*Page Number(s): _________________________________________________________

Chapter Title (for books and manuals): __________________________________________

Article Title (for newsletters and journals): ________________________________________

Author Name: _____________________________________________________________

*Volume and Issue Number (for newsletters and journals): ___________________________

*Copyright Year: _____________


*Distribution or Intended Use (Examples include, but are not limited to accreditation compliance, survey preparation, educational handout (non health care organization), publication in an article, book or magazine, consulting service, research, staff education (health care organization), seminar or conference.)
________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

*Number of Copies you would like to make: ____________________________________

*Internet Use (circle one):Yes..........No..........Does not apply

*Intranet Use (circle one):Yes..........No..........Does not apply

*CD-Rom Use (circle one):Yes..........No..........Does not apply


You will be contacted by telephone or Email to discuss any applicable fees.

Disclaimer: This permission request applies to the information/material specified above. New applications should be made for each subsequent use or for other uses of this information or material.