Late Submissions

Name*

First Last Suffix

Email*

Phone

Please only include the people who helped/will help you create the Powerpoint Presentation and/or will be presenting at the conference. We do not need the names of the people who contributed to the research discussed in the presentation.

Co-Contributor 1

First Name Last Name Suffix

Co-Contributor 1 Email

Co-Contributor 2

First Name Last Name Suffix

Co-Contributor 2 Email

Co-Contributor 3

First Name Last Name Suffix

Co-Contributor 3 Email

Additional Co-Contributors

Please enter any additional contributors' name and email below if you have more than 3 co-presenters/contributors:

You can submit proposals for three presentation formats:

20-Minute Innovation Presentation

Primary Care Practice or Education Innovation: A 20-minute presentation of your innovative project in your practice or education, followed by a 5 minute Q&A Session. The project may be completed or still in development. You may present preliminary data, but this is not a requirement.

50-Minute Innovation Workshop

Innovation Workshop: 50-minute presentation which walks participants through the approach, intervention, and outcome of an innovation in primary care, followed by a 5 minute Q&A Session. For example, how your team approached frequent hospital readmissions. You will be asked to provide a summary on how you will make the workshop interactive for the audience.

Innovation Poster

Innovation Poster: A poster presentation of your innovative project in your practice, to be presented during our poster session after the keynote. The project may be completed or still in development. You may present preliminary data, but this is not a requirement. PDF versions of posters with your contact information will be posted for participants to review and contact you for further discussion.

Select your preferred format*

Are you open to presenting in a different format other than what you selected above?

The conference directors will be reviewing proposals, and may request that you present in an alternate format than what you selected above.

Yes, I am open to presenting in another format
No, I would prefer to present only the above format

Innovation Title*

Innovation Description*

How does this innovation improve patient access, quality or the coordination of patient care? (1250 character limit)

Results*

If you’re planning to present the results of a project, describe your evaluation results (completed), or the evaluation method planned to obtain results (in progress). If evaluation is NOT relevant to your work/project, please enter N/A in this field. (1250 character limit)

How will you make the workshop interactive for the audience?*

References Provide 2-3 current (within the last 5 years) bibliographical citations supporting your presentation in AMA format: *All scientific research referred to, reported, or used in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis

Reference 1*

Reference 2*

Reference 3

Learning Objectives Provide 2-3 current objectives for your presentation. As a result of participation in this activity, participants will be able to...:

Learning Objective 1*

Learning Objective 2*

Learning Objective 3*

Material Release*

May we distribute your presentation material to learners?

Yes
No

Primary Care Innovations

Continuing Medical Education

PCI Proposal Sumbission 2021

Please only include the people who helped/will help you create the Powerpoint Presentation and/or will be presenting at the conference. We do not need the names of the people who contributed to the research discussed in the presentation.

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