Northeast Regional Telehealth Conference: Call for Presentations Survey

The Northeast Telehealth Resource Center is thrilled to host our next Regional Telehealth Conference in Portland, ME on June 5-6, 2018!

We invite you to complete this application to present a breakout session (one hour, scheduled on June 5 or 6).

The proposal deadline has been extended to Friday, March 9! Notifications will be made by March 30.

Presentations will be selected to create an agenda covering a wide variety of topics for a diverse audience, with a focus on highlighting regional programs providing practical strategies and resources for successful and sustainable implementation. Please note, NETRC is not able to accept proposals from representatives of for-profit companies. We encourage you to share this opportunity with customers and end-users.

Conference registration fees will be waived for one presenter. Travel and accommodations are not provided.

If you have any question, please contact Diane Campbell at dianec@mcdph.org or 207-622-7566 ext. 230

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* 1. Primary Presenter Contact Information:

Name:

Organization:

Email:

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* 2. (Optional) Secondary Presenter Contact Information (Conference fees can be waived for first presenter only):

Name:

Organization:

Email:

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* 3. Proposed Presentation Title:

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* 4. Please provide a brief description of the speakers' background/qualifications (if your presentation is accepted, updated bios/resumes will be requested for publication and for our CME application):

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* 5. Please provide a short description of your proposed presentation/breakout session:

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* 6. (If applicable/available) Please describe any outcomes and/or best practices that have resulted from your telehealth project/program:

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* 7. Will your presentation fit into any of these potential focus areas? (not required to be accepted)

Telehealth in an Federally Qualified Health Center or Rural Health Clinic

Telehealth in a Critical Access Hospital

Telemental Health/Telebehavioral Health

Remote Patient Monitoring

Direct-to-Patient or Direct-to-Consumer (in a non-medical location)

Legal & Regulatory Best Practices

Workforce Training/Education

Sustainability Strategies/ROI

Other - please provide a brief focus area that can be highlighted in our agenda (optional)

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* 8. Please identify three learning objectives for your breakout session:

Objective 1

Objective 2

Objective 3

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* 9. Breakout session are eligible for CME, and as such, commercial promotion/endorsement is prohibited. Please describe any conflicts of interest the speaker(s) may have.

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* 10. Which of the following days are you available to present?

Either June 5 or 6

Tuesday, June 5 only

Wednesday, June 6 only

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* 11. In addition to a formal presentation, would you consider co-moderating open forum discussion sessions?

Yes

Maybe, but I would need to learn more first

Many thanks for submitting a proposal!
Please do not hesitate to reach out with any questions (800-379-2012 or netrc@mcdph.org).