Please complete and submit this Clinical Job Order form and an M.E.D. recruiter will call your office to confirm receipt of the job order. We appreciate your business! CONTACT NAME: CONTACT E-MAIL: CLIENT: CONTACT TELEPHONE: TYPE OF ADMINISTRATIVE JOB ORDER: TEMPORARY TEMP TO PERMANENT PERMANENT POSITION TITLE : LOCATION : RATE OF PAY: DAYS OF ASSIGNMENT: TIME OF ASSIGNMENT: TEMP REPORTS TO : DRESS CODE: SCRUBS -- SPECIFIC COLOR: BUSINESS CASUAL OTHER -- PLEASE DESCRIBE: PLEASE CHECK THE REQUIREMENTS FOR THIS POSITION: INJECTIONS TRIAGE BLOOD DRAW PRECERTIFICATION VITALS PHARMACY CALLS WEIGHTS INSTRUMENT STERILIZATION EKG'S CLEAN AND STOCK ROOMS CASTING PFT'S SUTURE REMOVAL URINALYSIS HOLTER MONITOR X-RAYS PLEASE ENTER MEDICAL SOFTWARE PACKAGE NAME: ADDITIONAL SKILLS AND COMMENTS:   THANK YOU. If you have any problems using this form, please call our offices: St. Louis Office -- (314) 991-8806, or fax (314) 991-3752

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