Request for Clearance

NMCP REQUEST for MEDICAL EDITOR REVIEW

1. MCNCDCMSCCIV ADReserveCivilianOther XXX-XX- Position: SelectStaffResidentInternGraduate Student

Email: PH: PGR: FAX:

Department: Department Head:

Directorate: Director: Other:

2.Submission Title:

Submission Type:SelectAbstractCase ReportArticlePresentationBook ChapterBookLetterGovt Research ReportConsent FormResearch Protocol ApplicationOther Other:

3.If applicable, to be submitted for publication in:

If applicable, to be presented at:

Deadline for edit completion(m/d/yyyy):

4.Have youattached the current draft in as close to the required format as possible? YES NO.

5.Have you attached a copy of (or web link to) the publisher’s author guideline? YES NO.

6.Do you want journal specific formatting? YES NO.

7.Do you want editing for grammar, organization and clarity? YES NO.

8.Do you want your references checked by librarian/editor and corrected? YES NO. Have you used an electronic reference program to assemble your references? YES NO. If yes, what program?

9.If applicable, who is the corresponding author?

10.Does your manuscript include your required identification for all authors? YES NO.(Manuscripts and professional articles completed in an official capacity, or funded by the Government, must identify the author with complete name, military grade, title, and command. Contact the Command Publications Coordinator if you think an exemption applies to your authored work.

11.Does your manuscript include therequired disclaimer? YES NO. The following must be included in all materials (you may copy and paste it to your document):

Form Expires 30 SEP 07

NMCP REQUEST for MEDICAL EDITOR REVIEW

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Form Expires 30 SEP 07

NMCP REQUEST for MEDICAL EDITOR REVIEW

12.If this is research, does it have research approval? Not Research Related (Go to #13) Approved Research

NMCP CIP (# ) Other:

Study Design: SelectExploratoryDescriptive, RetrospectiveDescriptive, ProspectiveAnalytic, RetrospectiveAnalytic, ProspectiveOther: Study Status: SelectOpen to enrollmentOpen but closed to enrollmentCompleted in Good StandingSuspendedTerminated

PI:

Study Title:

Does your manuscript include the required CIP Statement? YES N/A.If CIP sponsored, the following statement must be included in your written material (you may copy and paste it to your document):

Form Expires 30 SEP 07

NMCP REQUEST for MEDICAL EDITOR REVIEW

Research data derived from Study Title, an approved Naval Medical Center, Portsmouth, VA IRB/IACUC protocol (CIP #).

Form Expires 30 SEP 07

NMCP REQUEST for MEDICAL EDITOR REVIEW

13.Does your manuscript contain the required copyright statement? Yes or Publisher agreement has government work statement (provide copy). N/A: Government or non-copyright protected forum.

Authors of official approved manuscripts cannot enter into any agreement that offers the publication exclusive rights. Government work, articles, and manuscripts prepared by Government employees in the course of their official duties, cannot be copyright protected. Most publishers recognize this copyright limitation and may have alternative acknowledgements. The following copyright statement should be attached to all Government work when submitted to civilian media for publication (you may copy and paste it to your document):

I am (a military service member) (an employee of the U.S. Government). This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

Form Expires 30 SEP 07

NMCP REQUEST for MEDICAL EDITOR REVIEW

14.Editing completion times:Authors are responsible for allowing sufficient time for the editing process. Please provide timely responses to the editor’s questions contained in emails and in the actual document. No response or a late response may result in the inability to meet the deadline. Please be sure to let the editor know when the process is complete or on hold. Length of time for the process is dependent on the number of editing requests in progress. Please be sure to include a reasonable deadline and all required information.

15. Optional comments/ special requests: ______

16. Author Signature: DATE:

Email this form and the publication materials to to start the process. Use “LastName Edit Request” in the email subject line. Contact the Medical Editor at 953-5939 if you have any questions.

Form Expires 30 SEP 07