2023 Abstract Submission Form - Case Report Question Title * 1. Abstract Title (please type in capital letters): Question Title * 2. Primary Author (include name, academic degree, e.g. Jane A. Doe, MD): Question Title * 3. Co-Authors (include name, academic degree, e.g. Jane A. Doe, MD): Question Title * 4. Residency Program Name and City (if applicable): Question Title * 5. Work Phone: Question Title * 6. Work Email: Question Title * 7. Presenter's name (person(s) who will make podium presentation or be present at poster during breaks): Question Title * 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 Question Title * 9. Has this abstract been presented previously at a national meeting? Yes No Question Title * 10. Has this abstract been published or accepted for publication? Yes No Question Title * 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 Question Title * 12. Have patient identifiers been removed? Yes No Question Title * 13. I attest that the above information is true and accurate to the best of my knowledge (enter your initials): Question Title * 14. Type or paste your abstract in the following fields. A total of 300 words are allowed across all fields. Objective: Question Title * 15. Case: Question Title * 16. Discussion: Question Title * 17. Conclusion: Question Title * 18. Comments: Done