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CHU Sainte-Justine

Mother and child university hospital center

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CHU Sainte-Justine

Mother and child university hospital center

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Form - Employees

Transmit us your demand

Mandatory fields are marked with a *

Identification

Name*:

Surname*:

You are*:

Researcher
Doctor
Healthcare Professional
Administrator
Other

Department*:

Immediate superior*:

Name of the person that approved this demand*:

Email*:

Phone number:

Partners inside Sainte-Justine UHC:

Partners outside Sainte-Justine UHC:

Project

Where is your innovation in the steps below*:

Needs assessment
Definition of the targeted public
Definition of the protocol, prototype
Redaction of collaboration agreements
Research and development, adaptation
Implementation in Sainte-Justine UHC
Impacts analysis
Valorisation, commercialisation

Description of the need / problem*:

Description of the solution / suggested innovation*:

Target definition

:

How many patients will be touched by this innovation?:

What type of clientele?:

How many families will be touched by this innovation?:

How many employees, by categories, will be touched by this innovation?:

Timeframe contemplated for the next steps

:

What resources (human, financial and material) do you have for your project?*:

What resources (human, financial and material) do you still need to acquire for your project?* :

Person that approved this budget?*:

Technologies that will be used*:

Competition assessment/
Do you know any other similar products being done elsewhere or in another format?:

yesno

Impact assessment/
What are the possible fallout for Sainte-Justine UHC (in terms of finance, visibility, publications, quality of care, etc.)?:

Risk related to the project:

Legal or clinical procedures are needed?*:

yesno

Information Technology /
What are your needs? Please explain briefly the system being created if related to informatics technology:

Does your solution impact on the current system?*:

yesno

How do you plan to implement your innovation in the UHC (strategy, training plan, steps of deployment, etc.)?:

Demand

Expected delay for this demand*:

Please explain your expectations regarding the innovation platform?*:

Would you be available to meet the coordinator of the platform to give details about your project?*:

yesno

Do you have any other comments or questions you would like to address?:

Security Code*:

Enter security code:

Security code

Please note...

The submission of the form does not engender automatically a help of the platform. The project has to be approves by the executive committee of the UTITAC.

About this page
Updated on 6/4/2015
Created on 6/4/2015
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