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THE HOSPITALIST SUBSCRIPTION FORM

You must be a hospitalist, resident, fellow, medical student, NP, PA, PharmD, or a member of SHM to receive The Hospitalist at no charge. If you wish to start a new subscription to The Hospitalist, please complete this form.

SECTION 1 - Please complete this section and proceed to either section 2, 3, or 4 below:
* Indicates required field

Name: *
Mailing Address: *
Telephone:
E-mail Address: *


SECTION 2 - If you are a Hospitalist or Physician Member of SHM, please complete the following. Otherwise skip to Section 3:

Indicate your clinical focus:


Indicate your employer model:
Other, please indicate:

Year you became a hospitalist:

Are you a member of SHM?
Yes
No

Education
Professional School:
Year Graduated:

Specialty:
Internal medicine
Pediatrics
Family practice
Med/Peds
ER
OB/GYN
Surgery
Psychiatry

Sub-specialty (check all that apply):
Allergy
Cardiology
Critical care
Endocrinology
Gastroenterology
Geriatrics
Hematology
Hypertension
Infectious Disease
Metabolism
Nephrology
Oncology
Palliative Care
Pulmonary
Rheumatology



SECTION 3 - If you are a Resident, Fellow, Medical Student, Nurse Practitioner, Physician Assistant, or PharmD, please complete the following. Otherwise skip to Section 4

Residents/Fellows/Nurse Practitioners/Physician Assistants
Indicate specialty/subspecialty:

Medical Students
Indicate current year of study and total length of program:

PharmD
Indicate employer model:


SECTION 4 - If you do not fall into any of the categories above, you can still subscribe to The Hospitalist for a fee::

Not eligible for free subscriptions

Paid Subscription Rates
Institutions: $150
Individuals: $75
Affiliate (e.g. administrator, CPA, public policy): $35