IDEOM Stakeholder Application

IDEOM Stakeholder Application
International Dermatology Outcome Measures (IDEOM) is a non-profit organization seeking to develop and validate measures throughout dermatology. IDEOM strives for the establishment of patient-centric outcomes to enhance the research and treatment of dermatological conditions. IDEOM seeks to bring together physicians, researchers, government agencies, pharmaceutical companies, payers and patients from around the globe to develop and validate measures throughout the field of dermatology.

To become a stakeholder with IDEOM, participation in Delphi surveys, web conferences, workgroups, and meetings will be required.

Please complete this application and submit a letter of interest in developing outcomes in dermatologic conditions or your personal experience. Please also submit a CV (patients need not submit a CV).

Please contact us at IDEOM@dermoutcomes.org if you have any questions.
Name*

First NameLast Name
Degree
Email*
example@example.com
Academic Title
Institution/Company
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Type of Stakeholder you would like to participate as:*

PhysicianPatient Research PartnerGovernmentPatient AdministrationNon-profitPayerCaregiverResearcherAdvanced Practice ProviderNurseMedical StudentFellow/Resident
Due to current budget constraints, caregiver participation is limited to situations where there is a documented medical need. A note from a licensed medical professional must be provided to support the request.

The nature of the condition that necessitates a caregiver is one that significantly impacts an individual’s ability to fully participate in discussions, decision-making, or activities due to physical, cognitive, or medical limitations. This could include, but is not limited to:
- Mobility impairments that require assistance with movement or positioning during the meeting.
- Cognitive or neurological conditions that affect memory, communication, or processing of information.
- Severe fatigue or pain-related conditions that limit independent engagement.
- Medical conditions that require immediate or ongoing support, such as medication administration or monitoring.
Our goal is to ensure that all participants, including patient research partners, have the necessary support to fully engage in discussions and contribute meaningfully to the IDEOM meeting. If a caregiver is required, we are happy to accommodate their presence as needed.
Please explain how you will support your Patient Research Partner during the IDEOM annual meeting:*
PRIMARY workgroup you are interested in participating in:*

AcneActinic KeratosisConnective Tissue DiseasesCutaneous T-Cell LymphomaHidradenitis SuppurativaItchPsoriasisPsoriatic ArthritisVitiligo
Other workgroup(s) you are interested in participating in:

AcneActinic KeratosisCutaneous T-Cell LymphomaHidradenitis SuppurativaItchPsoriasisPsoriatic ArthritisVitiligo
Who recommended you / how did you hear about IDEOM?*
List any significant publications in dermatology (if applicable):
Upload CV (not required for patients, but you are welcome to upload if you have)

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Brief narrative bio for any introductions:
Please explain your interest in IDEOM:*
Please verify that you are human:*
Should be Empty: