URMC / Libraries / Edward G. Miner Library / Ask A Librarian / Get Information for Your Patients Get Information for Your Patients Â鶹ÊÓƵ Use this form to request reliable and appropriate healthcare information for your patients and their families. Available to Â鶹ÊÓƵclinicians, social workers and staff. Searches are returned within 1 week. Fields marked with an * are required. Patient Information *Patient Name: *Date of Birth: *Medical Record Number (required) *Specify if Inpatient or Outpatient: Inpatient Outpatient *Specify Unit: *Phone Number or E-Mail for Patient/Family Member: I would like to review the information before it is sent to the patient/family member. Search Request Information *Describe Information Request:Include background information about condition/any complicating factors that should be considered in the information retrieval (include patient's age; no acronyms please). Healthcare Team Information *Healthcare Provider Name: *Phone/Pager Number: *Provider's Division/Community Practice Name: *Attending Physician: If you have trouble submitting this form call (585) 275-2487 for assistance.