Pediatrics, OB/GYN, and Family Medicine - Computer Purchase Request Form

Purchase Request *Requester: *Requester Email: *Recipient: *Recipient Email: *Description: *Department: [Select Department] Family Medicine - 1550 LKC OBGYN - 1595 Pediatrics     [Select Pediatrics Division] -Other Administration Allergy/Immunology - 1641 Ambulatory Pediatrics Anesthesiology Cardiology - 1642 Cedars-Sinai Center For Healthy Child Chairman Child Amputee Program Child Development Child Health Policy - 1638 Children's Health Center Critical Care - 1644 Cystic Fibrosis Developmental Studies - 1643 Emergency Medicine - 1640 Endocrinology - 1645 Fiscal Affairs Gastroenterology - 1646 General Pediatrics - 1647 Genetics - 1648 Hematology/Oncology - 1649 Hospitalist Program Human Genetics Infectious Disease - 1650 Information Systems Legal Fees Medical Education Molecular Genetics - 1654 Neonatology - 1651 Nephrology - 1652 Neurology - 1653 Obstetrics/Gynecology Olive View Outside Pediatrics Pain Management - 1639 Patient Billing Office Personnel Public Health Pulmonary Medicine - 1640 Quality Assurance Radiology Respiratory Medicine Santa Monica Group Student Health *Building: *Room: *Phone: *Amount Budgeted: *Is this being purchased with a Grant?: [Please Select] No Yes *Account: (See text below) Item Needed by Date: Item details or special instructions:     *To protect from spam-bots, what is the 5th letter of the alphabet? (capitalized)

* Indicates a required field By submitting this form with the account number, you are Approving the request. The item WILL be ordered, unless you specify otherwise under “Items details or special instructions” to delay any automatic processing. If you do not provide an account this will significantly delay the processing of this order. If the account is unknown then please enter UNKNOWN. Please note: If you enter UNKNOWN, the order will be further delayed until we can receive the appropriate account. Also, if your request is submitted too close to a fund ending, your order may also not be processed. Please submit these requests with the appropriate notice. It does take considerable time to quote these items, clarify requests being made, and to generate a PO through Bruinbuy. Pediatrics and Family Medicine Policy: No personal reimbursements will be processed on computer orders. All computer purchase requests must be made using this online form and processed through University systems. After-the-fact reimbursements are not allowed under department policies. Orders for the department of OBGYN will be processed by the OBGYN Admin office and per their internal policies.