Delirium Instruments Application Form

Delirium Instruments Application Form

Please fill out the following form for access to the Delirium Instruments video. All fields with an asterisk (*) are required. We will get back to you shortly after a review.
Delirium Instruments Submission

Thank you for your interest in the CAM and 3D-CAM delirium videos. We are delighted that you are interested in viewing these videos. Please answer the following questions about how you intend to use the delirium videos in order to request access. For more information about the CAM and 3D-CAM, please consult our website at:

Delirium Instruments

NOTE: BY LAW, DOWNLOADING OF THESE VIDEOS IS NOT PERMITTED.

Will you be using the videos for predominantly clinical or predominantly research purposes?

How do you plan to use these videos?

For each of the categories below, please indicate whether you plan to use the videos for the described purpose. If your answer is “yes,” please describe in detail your plans. If your answer is “no,” please write “none.” Please select all that apply. Research purpose, nonprofit (e.g., nonprofit academic uses, including student or university faculty papers, presentations, or student or faculty research for nonprofit academic purposes)?
Clinical use, nonprofit (e.g., direct patient care in a nonprofit setting)?
Educational or training purposes, nonprofit (e.g., training of students, hospital/research staff, families, caregivers in nonprofit settings)?
Any commercial use by a for-profit company or any industry usage?
Other planned use?

Disclaimer

These training videos are intended to assist with identifying the symptoms of confusion or delirium and are intended to be used as instructed. An accurate diagnosis for delirium, confusion, or other psychiatric disorders can only be made by a qualified healthcare provider or physician after a clinical evaluation. These materials are not intended to address the many situations that may arise in dealing with delirium, and persons must exercise their independent judgment about such clinical situations. The Hospital Elder Life Program, LLC., Dr. Sharon K. Inouye, MD, Hebrew SeniorLife, Dr. Edward R Marcantonio, MD or Beth Israel Deaconess Medical Center shall have no liability for claims by, or damages of any kind whatsoever to, a user of this material or any other person for a decision or action taken in reliance on the information contained in this video. Such damages include, without limitation, direct, indirect, special, incidental or consequential damages. YOU EXPRESSLY AGREE THAT THE HOSPITAL ELDER LIFE PROGRAM, LLC., SHARON INOUYE, M.D. AND HEBREW SENIORLIFE ARE NOT LIABLE FOR ANY INJURY, PHYSICAL OR FINANCIAL, RELATED TO THE CONTENT OR YOUR RELIANCE ON THE CONTENT. YOUR USE OF THESE MATERIALS CONSTITUTES YOUR AGREEMENT TO THE PROVISIONS OF THIS DISCLAIMER.