ICSI Publications Order Form
Print out this form and send to the Publications Fulfillment Center listed below.

Guideline Book & Pocket Guidelines

						  Price
						   per
						  Quantity   Each   Subtotal
 
___G97 1997 Guideline Book (2-volume set)	 ______  x  $250  = _______
___P98 1998 Pocket Guideline Book(see chart below)______  x ______ = _______
Pocket Guideline Chart
1-9= $10.00 ea.   10-24+ $9.00 ea.   25-49= $8.00 ea.   50-99= $7.00 ea.   100+ = $6.00 each
  						     Subtotal _________
			 If located in MN, add 6.5% Sales Tax _________
		   Shipping & Handling U.S. - $5.50 per order _________
					 Non U.S. - see chart _________
Non-U.S. Shipping & Handling Chart
Guideline Book= $40.00 per order
Pocket Guidelines (price per order) 
1-9= $15     10-24= $20     25-49= $25     50-99= $35     100+ call for quote


Individual Guidelines
Qty. Remit Heart Disease & Hypertension __G38 Congestive Heart Failure in Adults _____ x 25.00 _____ __G12 Diagnosis of Chest Pain _____ x 25.00 _____ __G15 Hypertension Diagnosis & Treatment _____ x 25.00 _____ __G28 Stable Coronary Artery Disease _____ x 25.00 _____ __G30 Treatment of Acute Myocardial Infarction _____ x 25.00 _____ __G40 Treatment of Lipid Disorder in Adults _____ x 25.00 _____ Mental & Behavioral Health __G39 Diagnosis & Management of Attention Deficit _____ x 25.00 _____ Hyperactivity Disorder __G13 Domestic Violence _____ x 25.00 _____ __G18 Major Depression, Panic Disorder, & _____ x 25.00 _____ Generalized Anxiety Disorder __G19 Major Depression in Specialty Care in Adults _____ x 25.00 _____ Musculo-Skeletal Disorders __G02 Adult Degenerative Joint Disease of the Knee _____ x 25.00 _____ __G03 Adult Low Back Pain _____ x 25.00 _____ __G36 Ankle Sprain _____ x 25.00 _____ Obstetrical & Related Care __G16 Intrapartum Fetal Heart Rate Management _____ x 25.00 _____ __G23 Preterm Birth Prevention _____ x 25.00 _____ __G24 Prevention, Diagnosis & Treatment of Failure to _____ x 25.00 _____ Progress in Labor __G35 Routine Prenatal Care _____ x 25.00 _____ __G32 Vaginal Birth After Cesarean _____ x 25.00 _____ __G43 Diagnosis & Management of Infertility _____ x 25.00 _____ Other Health Care Conditions __G05 Breast Cancer Diagnosis _____ x 25.00 _____ __G06 Breast Cancer Treatment _____ x 25.00 _____ __G21 Management of Type 2 Diabetes Mellitus _____ x 25.00 _____ __G37 Preoperative Evaluation _____ x 25.00 _____ __G31 Uncomplicated Urinary Tract Infection in Women _____ x 25.00 _____ __G46 Deep Vein Thrombosis _____ x 25.00 _____ __G47 Migraine Headache _____ x 25.00 _____ Preventive Services __G07 Cervical Cancer Screening (Pap Smears) _____ x 25.00 _____ __G08 Colorectal Cancer Screening _____ x 25.00 _____ __G17 Lipid Screening _____ x 25.00 _____ __G22 Immunizations _____ x 25.00 _____ __G25 Preventive Counseling and Education _____ x 25.00 _____ __G26 Preventive Services for Adults _____ x 25.00 _____ __G27 Preventive Services for Children _____ x 25.00 _____ __G29 Tobacco Prevention & Cessation _____ x 25.00 _____ Respiratory Disease __G33 Viral Upper Respiratory Infection in Adults _____ x 25.00 _____ __G34 Viral Upper Respiratory Infection in Children _____ x 25.00 _____ __G01 Acute Sinusitis in Adults _____ x 25.00 _____ __G11 Diagnosis & Treatment of Otitis _____ x 25.00 _____ Media in Children __G09 Diagnosis & Management of Asthma _____ x 25.00 _____ __G44 Rhinitis _____ x 25.00 _____ __G45 Acute Pharyngitis _____ x 25.00 _____ Worksite Guideline __G41 Worksite Hypertension _____ x 25.00 _____
Technology Assessments

__T1 Cochlear Implants _____ x 25.00 _____ __T2 High-Dose Chemotherapy with Autologous Stem _____ x 25.00 _____ Cell Support for the Treatment of Breast Cancer __T3 Excimer Laser Use in Ophthalmology _____ x 25.00 _____ __T4 Pancreas Transplants _____ x 25.00 _____ __T5 High-Frequency Chest Compression Devices for _____ x 25.00 _____ Cystic Fibrosis __T6 Intravenous Immune Gamma Globulin (IVIG) for _____ x 25.00 _____ Treatment of Neurological Conditions __T7 Lung Transplants _____ x 25.00 _____ __T8 Prostate Specific Antigen as a _____ x 25.00 _____ Screening Test for Prostate Cancer __T9 Screening Tests _____ x 25.00 _____ __T10 PET and SPECT Scans for the _____ x 25.00 _____ Evaluation of Epileptic Patients __T11 Interferon Beta-1B for Multiple Sclerosis _____ x 25.00 _____ __T12 Cardiac Rehabilitation _____ x 25.00 _____ __T13 Oral Devices for the Treatment of _____ x 25.00 _____ Sleep Apnea Syndrome __T14 Morbid Obesity Surgery _____ x 25.00 _____ __T15 Home Uterine Activity Monitoring _____ x 25.00 _____ __T16 Prenatal Ultrasound as a Screening Test _____ x 25.00 _____ __T17 Stereotactically Directed Fine-Needle _____ x 25.00 _____ Aspiration Biopsy (FNAB) and Core Biopsy of Nonpalpable Breast Lesions __T18 Acupuncture for Treatment of Chemical Dependency_____ x 25.00 _____ __T19 Intrathecal Baclofen Infusion for _____ x 25.00 _____ Controlling Spasticity and Spasms __T20 Tympanic Ear Thermometers _____ x 25.00 _____ __T21 EEG During Carotid Artery Surgery _____ x 25.00 _____ __T22 Transjugular Intrahepatic Porto-Systemic Shunts _____ x 25.00 _____ __T23 Lung Reduction Surgery _____ x 25.00 _____ __T24 Stereotactic Radioneurosurgery for Brain Lesions_____ x 25.00 _____ __T25 High-Dose Chemotherapy with Hematopoietic Stem _____ x 25.00 _____ Cell Transplantation for Treatment of Multiple Myeloma __T26 Botulinum Toxin Therapy _____ x 25.00 _____ __T27 Small Bowel Transplantation _____ x 25.00 _____ __T28 Tissue-Type Plasminogen Activator for _____ x 25.00 _____ Acute Ischemic Stroke __T29 Magnetic Resonance Angiography _____ x 25.00 _____ __T30 Dorsal Rhizotomy for Spasticity _____ x 25.00 _____ __T31 Densitometry as a Screening Tool for _____ x 25.00 _____ Osteoporosis in Women __T32 Pulmonary Rehabilitation for Chronic Obstructive_____ x 25.00 _____ Pulmonary Disease __T33 Genetic Screening for Breast Cancer _____ x 25.00 _____ __T34 Electron-Beam Computed Tomography for _____ x 25.00 _____ Artery Disease __T35 Electrical Stimulation for Non-Union of _____ x 25.00 _____ a Fracture __T36 Acupuncture for Chronic Osteoarthritis Pain, _____ x 25.00 _____ Headach, and Low Back Pain __T37 Computed Tomography for the Diagnosis of _____ x 25.00 _____ Pulmonary Embolism __T38 Assisted Reproductive Technologies _____ x 25.00 _____ __T39 Photodynamic Therapy for Head and Neck, _____ x 25.00 _____ Tracheobronchial, and Esophageal Cancer __T40 Screening for the Factor V R506Q (Leiden) _____ x 25.00 _____ Mutation Prior to Oral Contraceptive Prescription __T41 Minimally Invasive Direct Vision Coronary _____ x 25.00 _____ Artery Bypass Grafting (MIDCABG) __T42 Microwave Thermotherapy for Benign _____ x 25.00 _____ Prostatic Hypertrophy __T43 Antiviral Therapy for Chronic Hepatitis C _____ x 25.00 _____ Subtotal __________ If located in Minnesota, add 6.5% Sales Tax __________ U.S. address add $5.50 per order shipping & handling __________ Non-U.S. address add $15.00 per order shipping & handling __________ TOTAL AMOUNT DUE __________ Name _________________________________ Credentials _______________________ Affiliation _______________________________________________________________ Position __________________________________________________________________ Street Address ____________________________________________________________ City/State/ZIP ____________________________________________________________ Telephone ___________________________ Facsimile ___________________________ __ check enclosed (made payable to ICSI in U.S. dollars drawn on a U.S. bank) __ VISA __ MasterCard __American Express (credit card payments may be sent via fascimile to 612-545-0335) Credit Card # __________________________________________________________ Name on Credit Card ____________________________________________________ Expiration Date ________________________________________________________ Signature ______________________________________________________________

Return form to:
ICSI Publications Fulfillment Center
c/o the ARDEL group
13355 Tenth Avenue North, Suite 108
Minneapolis, MN 55441-5510
(612) 545-1919 telephone
(612) 545-0335 facsimile

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