1.Abstract Title (please type in capital letters):

2.Primary Author (include name, academic degree, e.g. Jane A. Doe, MD):

3.Co-Authors (include name, academic degree, e.g. Jane A. Doe, MD):

4.Residency Program Name and City (if applicable):

5.Work Phone:

6.Work Email:

7.Presenter's name (person(s) who will make podium presentation or be present at poster during breaks):

8.Presenter (check one - select category based on when research was completed): 

FM Resident

FM Residency Program Faculty

Practicing Family Physician

Medical Student who assisted FM Resident with research 

Medical Student who assisted FM Faculty with research

9.Has this abstract been presented previously at a national meeting? 

Yes

No

10.Has this abstract been published or accepted for publication? 

Yes

No

11.Previously Presented/Work In Progress Abstract Category:

This study/case has already been presented prior to the IAFP Research Day -OR- my data will not be complete in time for IAFP Research Day

12.Have patient identifiers been removed? 

Yes

No

13.I attest that the above information is true and accurate to the best of my knowledge (enter your initials):

14.Type or paste your abstract in the following fields. A total of 300 words are allowed across all fields.
Objective:

15.Case:

16.Discussion:

17.Conclusion:

18.Comments: