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The nomination package should consist of : 1 ) a letter of nomination ; 2 ) a seconding letter ( preferably from someone outside the nominee 's institution ) ; and 3 ) the candidate 's CV . In November 1989 , NLM Director Donald Lindberg , M.D ., sent a letter to hospital executives extolling the virtues of GratefulMed and how valuable it would be to hospital administrators . The review is in the form of a letter and it is entitled " Letter from London .