Request for Return of Record from Records Center / Out Card

Please complete one form for each file or box being requested.

NOTE: Items with an asterisk are required fields, and must be filled out before request can be processed.

Campus
Columbia Kansas City Rolla St. Louis UM System Hospital Ellis Fischel University Physicians

Date:

*Person Requesting Return:

*Requestor's Telephone Number:

*Requestor's E-Mail Address:

Date Needed By:

Time Needed By:

Department Requesting Return:

*Department Code:

Department Address:

Method of Return:

Special Instructions:

Records Center Box Location Number:

Needed:

Description:

*Indicates required field

Note: Please complete this form ONCE for EACH FILE OR BOX being recalled as each submission will generate a printed sheet that will serve as a checkout form for the record either in the box or on the shelf.