Student/Educational Request for ICSI Guideline Use
This request form is ONLY for students currently enrolled in a health care degree-seeking program in the state of Minnesota. ICSI reserves the right to verify this status by requesting a copy of a current academic schedule or current invoice for tuition.
Are you a currently enrolled medical student, studying in Minnesota?
College or University Name
Official school name
School Location (example: Minneapolis, MN)
City, State & Country
Your Field of Study (example: Internal Medicine)
If your request is approved, the guideline PDF(s) will be sent to you at this email address.
Phone Number (with Area Code)
ICSI Guideline(s) Requested
Adult Acute and Subacute Low Back Pain (Current revision underway)
Adult Depression in Primary Care (Revised 2016)
Diagnosis and Management of Diabetes Mellitus in Adults, Type 2 (Revised 2014)
Diagnosis and Treatment of Headache (Revised 2013)
Diagnosis and Treatment of Osteoporosis (Current revision underway)
Diagnosis and Treatment of Respiratory Illness in Children and Adults (Current revision underway)
Diagnosis of Breast Disease (Revised 2012)
Healthy Lifestyles (Revised 2016)
Heart Failure in Adults(Revised 2013)
Management of Labor (Revised 2014)
Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management (Revised 2016)
Palliative Care (Revised 2013)
Perioperative (Revised 2014)
Prevention and Management of Obesity for Children and Adolescents (Revised 2013)
Prevention and Management of Obesity in Adults (Revised 2013)
Preventive Services for Children and Adolescents (Revised 2013)
Stable Coronary Artery Disease (Revised 2013)
*Other (please specify in Other Notes field below)
All of the ICSI guidelines listed above
More than one guideline (please specify in Other Notes field below)
Please add any other special information about you or your request.
Date of Request
Agree to ICSI Licensing Terms
Do you agree to ICSI's Guideline Licensing Terms for students?
Send me a copy of my responses
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