2019 Presentation Proposal CtHIMA 2019 ANNUAL MEETING AUGUST 16, 2019 SHERATON HOTEL1001 CAPITAL BLVDROCKY HILL, CT 06067 PRESENTATION PROPOSAL Please submit your completed Presentation Proposal by April 30, 2019 for consideration as a 2019 CtHIMA Convention presenter. I. PROPOSED TITLE OF PRESENTATION Proposed title (10 words or less) * II. PRESENTER DETAILS Provide name, credentials, employer and title exactly as you want it to appear in the marketing and program materials. Name * First Name Last Name Credentials Employer * Job Title/Posiion * Primary Address * Street City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Email * Phone Are you completing this Proposal on behalf of the Presenter? * No, I am the PresenterYes If person completing this Proposal is not the Presenter, please provide the following details. Name First Name Last Name III. PRESENTATION INFORMATION Selected Topic * KeynotePatient EngagementPatient AdvocacyHIPAA/Proposed Changes in InteroperabilityTrends in Healthcare DeliveryPopulation Health (complexity in healthcare reimbursement)Other Presentation Summary: Provide a brief overview of presentation (up to 50 words, 3-6 sentences). Consider two or three powerful, focused sentences that summarize the presented content. Make it compelling to draw attendees. This summary will be included in the marketing and on-site program materials and should be suitable for publication with minimal editing. * Audio-Visual & Other Material Request: CtHIMA will provide an LCD projector, screen, laptop and wireless microphone in each session room. Rooms are not pre-equipped for internet or attendee laptops. Describe any additional requests (i.e. flip chart w/markers, internet, etc). IV. PRESENTER PROFILE INFORMATION Brief Biography: Provide a brief narrative biography for each Presenter (100-200 words). This will be used to introduce the Presenter at the beginning of the session and included in the presenter profile within the CtHIMA mobile event application. * Resume/Curriculum Vitae: This should include a listing of recent presentation experience. Headshot Photo (optional): CtHIMA includes photos in marketing and on-site program materials. Please upload a hi-resolution, color photo in JPEG, TIFF or EPS format. Company Logo Company will receive recognition in the marketing and program materials. Please provide the logo file in JPG, PNG, TIF or EPS format. V. EXPENSE REIMBURSEMENT REQUEST CtHIMA’s speaker budget is extremely limited and proposals are generally pro-bono or company sponsored. However, CtHIMA does offer other options to meet individual needs, and requests will be evaluated during the selection process. Please make selection(s): I am presenting pro-bono and DO NOT require an overnight stayI am presenting pro-bono and DO require an overnight stay I will be joining for lunch Reimbursement for expenses is requested for the amount of $ VI. POWERPOINT PRESENTATION / HANDOUT MATERIALS Presentation materials are required and should be submitted to CtHIMA by July 15th, 2019. PowerPoint is the preferred format, and CtHIMA will utilize your PowerPoint as the program handout (converted to PDF). Handouts are posted on the CtHIMA website and available exclusively for registrants a few weeks prior to the event. Materials are distributed electronically only; printed materials will not be provided. Attendees will be emailed access to download and/or print materials in advance. VII. AGREEMENT I will inform CtHIMA immediately if for any reason I will be unable to do the agreed upon presentation. I agree to provide CtHIMA with a master file of my presentation (i.e. PowerPoint file) and any additional materials in the approved format by the deadline. I understand that my presentation will be utilized as a handout and posted on the CtHIMA website for access to attendees. Signature * Date