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UK Interpreter Request
Request a Spoken Language Interpreter (University of Kentucky)
Name of requestor:
*
First
Last
Language
*
Arabic
French
Japanese
Russian
Spanish
Ukrainian
Center
*
Fountain Ct - 245 Fountain Ct
Good Sam MOB/Maxwell - 125 E Maxwell St
KY Children's Rich Rd - 1900 Richmond Rd
Polk Dalton - 217 Elm Tree
Other
Center Information
*
Please let us know the Center name and Center Address
Clinic
*
Psychiatry 3rd fl
Primary Care 1st fl
Clinic
*
OBGYN Suite 140 & Suite 300 (please specify suite in notes)
Clinic
*
NICU Grad 1st fl
NICU Complex Care 1st fl
NICU Neurology 1st fl
Developmental Pediatrics 1st fl
Pediatric Physical Medicine & Rehab 1st fl
Clinic
*
OBGYN
Internal Medicine
Direct contact phone number
*
Email of Requestor
*
Section Break
Name of person(s) who will be receiving interpreting services
First
Last
Date (s) needed
*
Time of appointment
*
Time requested for arrival
*
Length of time needed
*
(2 hours are standard - please indicate if longer time is needed)
Patient Date of Birth
*
MM slash DD slash YYYY
Medical Records number
*
Provider Name
*
Please briefly describe the nature of the appointment
*
Notes or special requests:
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