Patients First Program Application

Putting Patients First Program Application

The AHRA & Canon Medical Systems USA, Inc. Putting Patients First Program seeks to improve pediatric and adult patient care and safety in diagnostic imaging through an innovative grant- making program. The Putting Patients First Program will provide four grants in 2023 to fund programs, training or seminars aimed at improving patient care and developing best imaging practices in the areas of CT, PET/CT, MR, Ultrasound, X-ray and Vascular. This collaboration seeks to improve patient care and safety in imaging through grants that fund programs, trainings and seminars at IDN/hospital systems, local hospitals and imaging centers. The programs funded by these grants will be used to create a best-practices tool to share with other hospitals and institutions. (Applicants must be from the USA)
Full Name*

First NameLast Name
Title
Department
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
AHRA Member?

YesNo
How did you hear about this grant opportunity?
Organization Section
Organization Name*
My organization is*

IDN/health systemSingle-site hospitalSingle-site imaging center
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Program Overview
Which patient population will this program target?

PediatricsAdult patient careOverall patient careOther
What type of program is your single-site hospital or imaging center hoping to fund with the grant?

A program focusing on diagnostic imaging ($10,000 grant)A program focusing on pediatric imaging ($10,000 grant)A program focusing on oncology imaging ($10,000 grant)Other
Are you applying for the IDN/health system grant? ($20,000 grant)

YesNo
Title for this program:*
In fewer than 800 words, describe your organization’s plan for creating and implementing the program. Please highlight how your program will improve patient care and safety. Describe the shape the program will take (traditional program, staff training, seminar or another format), main objectives/goals, timing and anticipated outcome.*

0/800
For IDN/hospital systems only: In fewer than 500 words, describe specifically how your program will be implemented across the entire IDN/hospital system, including the plan to ensure quality, consistency and compliance across the entire hospital system.

0/500
In less than 100 words, describe how the “best practices” learned from the program can be shared with across the hospital system for IDNs or with other facilities for single-site hospitals and imaging centers.

0/100
Additional information/comments.
Senior Management support: (required, upload letter below)
In less than 100 words, describe your show of support for the program.

Do you have additional files/documents that you feel would be helpful in your application? You can attach the files below. (optional)
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*I certify this application contains no misrepresentations or falsifications and this information is true and correct to the best of my knowledge. I understand that any false statements made herein will void this application and I will be ineligible for support from Putting Patients First Program. I have read the eligibility requirements and certify that I and my facility are eligible for this grant. I also certify that I understand and agree to the funding overview, judging, timing and program criteria as stated in this application.*

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Putting Patients First Program Application

Organization Section

Program Overview