Submit a request – American Medical Association

Please select your request type. Once submitted, a ticket confirmation screen will provide a summary of the information you've provided (All AMA employees must be logged in to submit requests)

Your email address

Subject(optional)

Primary Contact Name

Who should be contacted for follow ups?

Primary Contact Phone Number

Legal Organizational Name

Please provide the legal name of the institution, company, or other entity that will appear on the contract

Company Address - Country

Address Line 1

Address Line 2(optional)

City

State

Zip

Organization Web Site(optional)

Please provide a valid URL

Organization Affiliation(optional)

Please list any specialty societies or industry associations that your organization is member to or affiliated with

Detailed description of the AMA content that you wish to use.

In a few sentences, please provide a detailed description of the AMA content you wish to use. If your request includes CPT Codes, please provide the code number, section, and page number in a separate document (excel or word).

What kind of material is the original source of AMA content?

Was this a printed publication, online publication, web site link, etc

Title

Please provide the name of the requested content ("CPT Professional 2021")

Author(optional)

Please provide the author name if applicable

Edition and/or volume of book or article(optional)

Please provide the book edition or the journal volume of the requested content

Copyright date

Please provide the copyright year of the requested content

URL Address(optional)

Please provide the URL to the requested content (eg. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-of-medical-ethics.pdf) or use 'n/a' to indicate that this content is not available online

Please provide the specific chapter name(s), article title(s), page number(s), image(s), table(s) or other AMA Content proposed to be used

Quantity/volume of AMA Content to be used

Please explain the quantity/volume of AMA Content to be used - for instance the number of CPT codes, pages of content, number of paragraphs.

Description of proposed usage

Please describe your upcoming publication or work and describe how AMA content will be incorporated in your content.

What is the format of the work?

Please choose any applicable standard formats. If other, please describe below

If other format, specify type

Please describe the proposed usage type or use 'n/a' if described above

If web-based, will access to the work be password protected?

If web-based, number of people who will have access to the work.

Use '0' if not web-based

If web-based, describe any other restrictions on access.

If none, please type "none"

Please describe your publication in detail

Please provide all that apply: Author, Title, Chapter or Article title, Edition/Volume, Copyright Month and Year, Publisher, URL

How will your product containing AMA content be published?

In what context will it appear?

Proposed duration for use of AMA content (may not exceed 3 years)

Term may last either less than 1 year, 1 year, 2 years, or 3 years (max).

Country of the proposed use

Where do you intend your content to be accessible?

Intended Audience

Please describe the main intended audience for your work, for instance: medical staff, students, practitioners, physicians, internal staff

Indicated use

Please select the primary use of your proposed content

Will the Work be sold or licensed or otherwise be used to generate any fee or revenue?

What is the price and number of units that are expected to be sold, licensed and/or distributed?

Complete AMA Content/publication distributed?

Are students required to purchase AMA Content/publication?

Are students charged for class?

Price charged for class

Please provide the cost to the student for the class or 'n/a' if none

Are students charged for classroom materials?

Price for classroom materials(optional)

Please provide the cost to the student for the class materials; enter zero if none

Will you be the signer of the agreement?

This is the person authorized to execute contracts on behalf of your organization

Signer of contract(optional)

Who will be signing relevant contract for your organization

What is the contract signer's email?(optional)

This will be used to send the agreement

Check to confirm that by submitting this Application, Requestor confirms that the information provided is accurate to the best of their knowledge.

Note: Permission cannot be granted for usage of material that is not copyrighted by the American Medical Association. Requests for permission are granted at the AMA’s sole discretion. No permission is granted unless and until you receive a written permission letter from the AMA.

Comments or Questions

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