Anatomical Specimens Request

As delineated in the Use of Cadavers and Recognizable Human Body Parts for Educational and Research Purposes Policy, and with the exception of NIH-sponsored research and/or IRB-approved research, cadavers and/or body parts intended for use or storage on University premises must be requested via this electronic Anatomical Specimens Request and submitted to the proper Anatomical Specimens Coordinating Department. (Based on the selections you make and details your provide below, your request will automatically be directed to the appropriate department.)

Additionally, the University procures all specimens from University approved suppliers only. If this request is anatomical specimens from a non-approved vendor, you must receive additional approval directly from the appropriate Anatomical Specimens Coordinating Department (e.g. the Feinberg Augusta Webster, MD, Office of Medical Education (Feinberg AWOME), Northwestern Simulation (NUSIM), or the Office for Research Safety (ORS)) prior to receiving confirmation and specimen procurement. If this is a special request from a specific vendor, please check the box below and specify the vendor in the designated space.

Special Request from a Specific Vendor
Specify Vendor:
Vendor's Contact Name: Vendor's Contact Name: First Last
Vendor's Email Address:
Requestor Information
Requestor Name Requestor Name First Last
Title
School
Department/Division
Office Location
Email Address
(Must be an on-campus email address (e.g., @northwestern.edu, @nm.org, etc.)
Office Phone Number Office Phone Number - ### - ### ####
Cell/Pager/Other Phone Number Cell/Pager/Other Phone Number - ### - ### ####
Attending Physician/Principal Investigator Name (if requestor is a trainee (resident or fellow)) Attending Physician/Principal Investigator Name (if requestor is a trainee (resident or fellow)) First Last
Attending Physician/Principal Investigator Email Address
Attending Physician/Principal Investigator Office Phone Number Attending Physician/Principal Investigator Office Phone Number - ### - ### ####
Reason for Request
Select one reason:
Please provide details regarding the surgical focus of your request including a summary of how the anatomical specimens will be utilized.
Anatomical Specimen Information
Request Type

Request Type Whole Body Cadaver(s) Recognizable Human Body Part(s)
Quantity/Amount Needed
Description of anatomy specifics (e.g., disarticulated, cut at the shoulder, etc.).
Additional Notes:
Is this a Preliminary Quote or Procurement? Please select one:
The Anatomical Office will forward a quote for your approval prior to ordering. Tissue will not be ordered until the quote is approved. A valid chart string is required to be submitted.
Chart String
Please enter your chart string as Fund-Department-Project (if applicable)-Activity (if applicable)-Expense Code
(This information is used for department identification and funds source verification only; funds will be requested after use date.)
Date Needed Date Needed / MM / DD YYYY
Anticipated Date of Return Anticipated Date of Return / MM / DD YYYY

All anatomical specimens within one year from the date of receipt.
The Anatomical Specimens Office will contact you around the return date to coordinate the transfer.
Laboratory/Specimen Use Location:
Additional Information
If this request for anatomical specimens is accepted, I/We hereby agree to follow all of the terms of the Northwestern University Policy on the Use of Cadavers and Recognizable Human Body Parts for Educational and Research Purposes.

If this request for anatomical specimens is accepted, I/We hereby agree to follow all of the terms of the Northwestern University Policy on the Use of Cadavers and Recognizable Human Body Parts for Educational and Research Purposes. I/We Agree

Upon approval of this request, the Anatomical Specimens Coordinator will be in contact with you to confirm the details.

Anatomical Specimens Request

Anatomical Specimens Request

Requestor Information

Reason for Request

Anatomical Specimen Information

Chart String