ADA: IDNT Permission Request Form

You can use this online form to:

	Request permission to REPRINT portions of the International Dietetics and Nutrition Terminology (IDNT) Reference Manual or Pocket Guide. Request permission to LICENSE the NCP/SL terms for "internal use" in an electronic health record or for distribution. Request permission to purchase an electronic copy of the current version of the IDNT Reference Manual. Please note. If you wish to reprint the Nutrition Care Process Model or any portion of the Nutrition Care Process/Standardized Language (NCP/SL) that appears in the Journal of the American Dietetic Association, you need to contact Elsevier's Global Rights Department at healthpermissions@elsevier.com. If you have question about completing this form, please email ncpslpermissions@eatright.org.

Questionaire

Do you intend to use or adapt any part of the IDNT Reference Manual or Pocket Guide in a printed or copied document?

Yes

Do you intend to offer the printed or copied doc for sale?

Yes

Do you intend to use or adapt any part of the IDNT Reference Manual or Pocket Guide in an electronic media (e.g. CD, software program, PDA software, intranet or internet website?)

Yes

Do you intend to embed the terminology within software programs (e.g. within electronic health records as drop down boxes or pick lists, or other decision support software?

Yes

Will it be for sale?

Yes

Requestor Information

	Contact Person
	Company Name
	Parent Company Name (if applicable)
	Street Address
	City
	State
	Zip
	Country
	Phone
	Fax
	Email
	Web Address

Billing Information

	Contact Person
	Street Address
	City
	State
	Zip
	Country
	Phone
	Fax
	Email

Person Authorized to Sign Contract

Please provide the name and contact information for the person who can sign a licensing agreement with the American Dietetic Association.

You, the requestor

Individual authorized to sign contract

Contact Person

Street Address

City

State

Zip

Country

Phone

Fax

Contactor contact details

Publication Information

Title: International Dietetics and Nutrition Terminology, 2009

Please Verify the ISBN number with the edition that you are using.
Please specify the content you wish to use (include all applicable page/figure/table numbers):

Product Information

Please include information about the product in which you will be reprinting the NCP/SL terminology.

Product Name

Describe the product in sufficient detail to provide a conceptual understanding. Include information about how the NCP/SL terminology will be used in the product. If possible, please attach sample pages and/or screen shots from the product showing how the NCP/SL terminology is used and displayed.

Describe the intended use of the product.

Describe the target audience of the product.

In which countries will the product be distributed

Publisher

Projected Publication Date

Intended Audience

Format of Your Work (please check all that apply)

Print (i.e., book, journal, etc.)

Course pack for students

CD-ROM

WWW

What is the URL where the content will be located?

Is the website password-protected, or is access to the content limited in any way?

Yes

How many users will have access to the content?

How long will the content be posted (not to exceed a 2 year limit)?

From

Intranet

What is the URL where the content will be located?

Is the website password-protected, or is access to the content limited in any way?

Yes

How many users will have access to the content?

How long will the content be posted (not to exceed a 2 year limit)?

From

Other

Product Information for electronic media (not for sale)

In what software or type of operating system will the NCP/SL terminology be used?

Will the IDNT terminology for the NCP be used for.

Internal use (within your organization electronic health records)

External use (distribution for sale)

Describe how the IDNT terminology will be used internally.

How many users will have access to the IDNT terminology in your software or system?

Will any members of your organization distribute the IDNT terminology externally?

Yes

If yes, please explain.

Will the IDNT terminology be accessed by users at a separate legal entity (e.g., parent companies, subsidiaries, clinics, etc.)?

Yes

If yes, please explain.

Will the IDNT terminology be accessed by users outside of the United States? If yes, in which countries?

Yes

If yes, in which countries?

Will your use of the IDNT terminology include the Internet?

Yes

If yes, please explain.

Preferred format for delivery of IDNT terminology, select one

Additional Information:

	If you do not intend to use or adapt the IDNT Reference Manual or Pocket Guide in printed, copied, or electronic media, you do not need to complete a permission request. However, if you believe you received this message in error, please recheck your question responses and/or send an email to ncpslpermissions@eatright.org. Thank you!