Letter of Intent for MDS Video Challenge 2022

Letter of Intent for MDS Virtual Video Challenge 2023

Submission Deadline: March 30, 2023
NOTE: Cases that are to be presented at the MDS Video Challenge should not be presented as an abstract in the Poster Areas. Cases will not be accepted if they have been previously published.
Contact Person
Full Name

First NameLast Name
Email
example@example.com
Organization/Group Submitting Case
Name of Organization/Group

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Case Submission #1
Title of case (please do not include any diagnostic information in the title):
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
Final diagnosis of case:
Case Submission #2
Title of case (please do not include any diagnostic information in the title):
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
Final diagnosis of case:
Case Submission #3
Title of case (please do not include any diagnostic information in the title):
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
Final diagnosis of case:
The author(s) of the Work hereby represents and confirms that he/she has obtained the written consent of any and all patient(s) featured or who are otherwise identifiable or used in the Work to such feature, identification or other use therein and that said consent fully complies with all applicable legal requirements relating to the use of said such patient identifiable material, including, without limitation, if applicable, the specific requirements of the United States Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
By submitting this Letter of Intent, you agree to the above and your case(s) will be reviewed by a committee. By the end of April 2023, notifications will be sent out indicating the cases that will be formally considered for review and possible presentation.
Should be Empty:

Letter of Intent for MDS Virtual Video Challenge 2023

Contact Person

Organization/Group Submitting Case

Case Submission #1

Case Submission #2

Case Submission #3