SimUAB | UAB

Reserving a Kit

Please note: To check out
the tabletop kit, you must
have completed the
Opioid Facilitator Training
Workshop

For questions about the
simulation, please contact
simuab@uab.edu.

Opioid Kit Loan Form

"Addiction is a DISEASE, I truly believe this is not common knowledge and this was a great way to learn and understand this concept."

"It definitely gave perspective from the patient’s point of view."

"It really opened my eyes to how impactful this disorder is."

Opioid Kit Loan Form

Please use this form if you are interested in borrowing an Opioid Simulation kit. Please note loans must be picked up from UAB Clinical Simulation in UAB Hospital by an individual. Please complete the form below and a SimUAB® team member should contact you within 24 business hours. Borrower is responsible for damages to kits while on loan. Kits must have scheduled pick-up and return times scheduled with SimUAB® personnel during routine business hours, Mon-Fri 8am-5pm. For additional assistance please contact simuab@uab.edu .

Requestor Name

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Phone

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Employer

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If other, please specify

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Blazer ID

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Title

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Approximately, how many learners will be participating?

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How many kits do you need?

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When will you pick up the kit(s)?

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When will you return the kit(s)?

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Please list any comments

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