01 Introduction
02 Invention Details
03 Source of Funding
04 Inventor Details
05 Inventor Technology Assesment

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The following questions apply to Healthcare Information Technology (HIT) Inventions (e.g. software, websites, mobile apps) only and are optional.

11. As part of the Commercialization process your invention will be reviewed by a group of peer providers (Peer Review Committee). Please select one or two Peer Review Committees that are most relevant to provide clinical and technical feedback on your invention.

MedStar Health is required to report government funded inventions to relevant funding agencies and provide a confidential copy of the disclosure. If an invention is made using industry or foundation funds, we are obligated to report such inventions to the sponsor, in accordance with the associated research grant/contract.

Please identify any financial sponsors of the invention, as well as the relevant grant/contract numbers. Include institutional or department funding.

List all persons who have directly contributed in the development or conception of the invention. All individuals who have made any inventive contribution must be listed for a valid patent application to be filed. 

Inventor 1*


*The Lead Inventor will be Inventor Services’ main contact for the invention, and is responsible for sharing correspondence with other inventors listed on this document and assisting in the completion of tasks.

Assignment: By signing this invention disclosure, each inventor hereby assigns and agrees to assign all rights, titles and interests to MedStar Health and denotes that inventor also agrees to cooperate in the filing of patent applications and the commercialization of the technology.



Please include all additional inventors:

Inventor 2

Assignment: By signing this invention disclosure, each inventor hereby assigns and agrees to assign all rights, titles and interests to MedStar Health and denotes that inventor also agrees to cooperate in the filing of patent applications and the commercialization of the technology.

Inventor 3

Assignment: By signing this invention disclosure, each inventor hereby assigns and agrees to assign all rights, titles and interests to MedStar Health and denotes that inventor also agrees to cooperate in the filing of patent applications and the commercialization of the technology.

Inventor 4

Assignment: By signing this invention disclosure, each inventor hereby assigns and agrees to assign all rights, titles and interests to MedStar Health and denotes that inventor also agrees to cooperate in the filing of patent applications and the commercialization of the technology.

Inventor 5

Assignment: By signing this invention disclosure, each inventor hereby assigns and agrees to assign all rights, titles and interests to MedStar Health and denotes that inventor also agrees to cooperate in the filing of patent applications and the commercialization of the technology.

Please answer the following questions as completely as possible for consideration by the Peer Review Committee.