Institute for Technology in Health Care Clinical Solution Award

PRO TIPS:

Please fill out the following form carefully and completely, noting all of the required fields.
All email addresses must be in valid xx@xx.xx format.
16 MB limit on all file uploads.
Your nomination is only submitted once you have reached a screen with a green top bar saying “Thank you for taking this survey”.
Files and supplemental materials may be emailed to awards@aami.org.
Please direct any questions or support needs to awards@aami.org.

Nominee Information:

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* 1. Nominee's Name:

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* 2. Title:

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* 3. Company/Affiliation:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

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* 7. Group Nominee Information

If this nomination is for a group or team, please attach the information from the previous entry for each member of the group/team.

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Nominator Information:

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* 8. Nominator's Name:

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* 9. Title:

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* 10. Company/Affiliation:

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* 11. Mailing Address:

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* 12. Phone Number:

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* 13. Email Address:

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* 14. Are you affiliated with the nominee? Note yes or no, and if so, describe your affiliation:

Award Criteria: Nominees must meet all of the following:

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* 15. Nominee has creatively and with innovation applied clinical engineering practices to fundamentally solve a problem or challenge that resulted in the improvement of healthcare delivery for (or well-being of) a patient population, community, or group. Please describe:

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* 16. Nominee’s solution works for or is employed in a clinical setting (hospital, ambulatory clinic, learning institution, or other healthcare setting). Please describe:

Award Criteria: Nominees should meet the following:

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* 17. Nominee has published the results of a study that provides a practical solution of a patient care problem or challenge through the application of clinical engineering ingenuity. Please describe:

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* 18. Nominee has demonstrated a clear example of intention to promote the continued advancement of HTM applications and innovations to a specific patient care problem or challenge. Please describe:

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* 19. Nominee’s nominated solution has involved multiple disciplines or healthcare professionals including, information technology specialists, nurses, physicians, medical technicians, researchers, etc. Please describe:

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* 20. Nominator Cover Letter:

Upload nominator’s cover letter that provides a rationale statement describing the nominee’s solution and how this solution can be applied by the broader medical or healthcare technology management (HTM) field in multiple clinical settings for the benefit of multiple patient populations, communities or groups.

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* 21. CV/Resume:

Upload a current CV/Resume for the nominee(s) here.

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* 22. Letter of Recommendation:

Upload a letter of recommendation (from the past year) supporting this nomination from supervisors, colleagues, and industry partners here.

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* 23. 2nd Letter of Recommendation:

Upload an optional additional letter of recommendation (from the past year) supporting this nomination from supervisors, colleagues, and industry partners here.

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* 24. Nominators are encouraged to submit examples and/or supporting documents that highlight additional activities relevant to this award.

Please upload any desired supporting documents here.

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