PACEP SA26 CPC/Keystone Case Submission
*Submission deadline is Monday, January 12, 2026. Please email alexandra.amaducci@gmail.com with any questions.
I would like to be considered for the following presentation options:
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Case Competition
CPC
Both
Submission Date:
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-
Month
-
Day
Year
Primary Presenter First Name:
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Primary Presenter Last Name:
*
Primary Presenter Credentials:
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Primary Presenter Email
*
example@example.com
Primary Presenter Cell Number
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-
Area Code
Phone Number
Primary Presenter Institution:
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Primary Presenter ACEP Number:
Contact information if submission is being completed by someone other than primary presenter:
Name, Email, Phone Number
Contact information if submitting for CPC Faculty Discussant:
Name, Email, Phone Number
Please list ALL authors in order if the submission is being considered for the case competition. Remember to appropriately place the presenting author in this list.
First Name
Last Name
Credentials
Level of Education/Training
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Author:
Attending
Fellow
Resident
Medical Student
Undergraduate/Graduate Student
High School Student
Other
Case Title
*
Please upload CPC and/or Case Competition file as a Word, PDF or PowerPoint file.
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Browse Files
If selected, a PowerPoint presentation will be required for the conference.
Cancel
of
I certify that this case is fully HIPAA compliant.
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Yes
No
I acknowledge that if accepted, the primary presenter will present in-person at PACEP SA26 at Kalahari and must register for the conference.
*
Yes
No
I acknowledge that if my submission is accepted to PACEP SA26, I give permission for its content to be shared in PACEP communications, including the PACEP Newsletter, website and social media.
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Yes, I agree
No, I do NOT agree
Signature
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Submit
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