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Stanford Medicine X ePatient Application 2013

Home / Stanford Medicine X ePatient Application 2013

Stanford Medicine X ePatient Scholarship Application 2013

We are so excited that you are interested in applying for an ePatient scholarship to attend Stanford Medicine X in the Fall! If you haven't yet done so, please take a moment to review information about the scholarship program.

Please note that this page may time-out (refresh) after a period of inactivity, causing you to lose any unsaved content. We recommend you type your application into a word processor and then cut and paste the text into the online form for submission.
1 Scholarship Application
2 Financial Application
  • Applicant Information

  • Photo

    Why do we need this? If you win a scholarship, we would like to recognize your accomplishment on our Medicine X website. By uploading your photo, you agree to give us permission to use it on our website. We will also need your photo to create an ID badge for the conference.
  • Please upload a digital photo of your face for use by Medicine X on our website and on your ID badge in the event that you are award an epatient scholarship. (JPEG, PNG, GIF are all acceptable formats).
  • Scholarship Track Preferences

    Please refer to the ePatient scholarship program page for more information about the different tracks. You may apply in only one track.
  • General Applicant Questions

  • We would like to be clear in our belief that everyone will be or has been a patient at some point in his/her life.

    However, the candidates that will be most successful in obtaining a scholarship will be the ePatients who are engaged in their community, for example, those that work with ePatient organizations or have shown in the past that they engage the public as ePatients through social media or blogging. Other considerations also include patients who have experience being empowered (usually by technology), equipped (by knowledge), engaged (in their care) and enabled (to care for himself or herself).
  • Engagement & Producer Track Questions

    Description: The purpose of the engagement track is to provide an opportunity for epatients to attend Stanford Medicine X and engage with the community, both at the conference, and with the larger world through social media. Besides providing a patient voice to the proceedings, scholars will help share and disseminate the knowledge they learn to further educate and inspire others.

    Selection Criteria: Successful applicants will demonstrate a history of patient engagement and community outreach and advocacy, with preference for individuals using emerging technologies such as blogs, Twitter, and social media to pursue these goals.

  • Presenter Track Questions

    Description: The purpose of the presenter track is to provide an opportunity for epatients to attend and speak at the Stanford Medicine X conference. By providing a patient voice to the proceedings, scholars will help share and disseminate the knowledge to educate and inspire others.

    Selection Criteria: Applicants will be asked to submit a speaking proposal that describes their story and what they would like to speak about. Patient talks in the presenter track will be five minutes in length and follow a pecha kucha/ignite format. Applications will be considered for talks in the following topic areas:

    • On the ePatient: How do you consider yourself an epatient?
    • On Participtory Medicine: How do you participate in your own care?
    • On Problems and Hurdles: As an epatient, what hurdles have you encountered and how did you overcome them?
    • How does technology enable you to care for your loved one?
  • Design Track Questions

    Description:The purpose of the design track is to provide an opportunity for epatients to serve as the inspiration and nexus of a patient-centered design project facilitated by the health and wellness team at IDEO. Besides providing a patient voice to the proceedings, scholars will help share and disseminate the knowledge to educate and inspire others.

    Selection Criteria: We are interested in receiving applications from patients who are passionate about adding the patient voice to the process of solving health care problems. Patients should have experience in managing a chronic disease and use technology to help facilitate their own care. Successful applicants will be able to articulate why their chronic medical problem needs thoughtful problem solvers and design thinkers to help improve their care. The successful applicant will then work with an IDEO designer to draft a problem statement that will become the focus of the Stanford Medicine X Design challenge. The winning team will have the opportunity to present their work from the Medicine X main stage.

  • Participation in the design track requires sharing your personal story and working with an IDEO designer between March 15 and April 15, 2013 to develop a problem statement for the Stanford Medicine X | IDEO design challenge workshop. You must agree to participate in the Medicine X | IDEO Design Challenge workshop, work with an IDEO designer to develop a problem statement, and present your project to the challenge jury and (if selected) on the Medicine X main stage.

  • Leadership Track Questions

    Description: The purpose of the leadership track is to provide an opportunity for epatients to attend Stanford Medicine X and gain leadership skills and experience in order to develop a new generation of epatient leaders. Scholars will be paired with leadership mentors (epatients who have attended a previous Medicine X conference), lead epatient activities and help share and disseminate the knowledge they learn to further educate and inspire others.

    Selection Criteria: Successful applicants will demonstrate a history of patient engagement and community outreach and advocacy, with preference for individuals using emerging technologies such as blogs, Twitter, and social media to pursue these goals. Successful applicants should demonstrate leadership potential and articulate how they would use a leadership position in the epatient community to advance their specific goals and objectives.

  • The leadership track is a two-year opportunity designed to nurture a new generation of ePatient leaders engaged in the use of health information technologies to empower peer-to-peer healthcare, participatory medicine and patient-centered care. We ask for applicants to commit to attending two consecutive years of Medicine X (2013 and 2014).

  • Consent to Contact

  • Financial Application

    Financial scholarships are intended to support ePatient scholarship recipients with the greatest financial need. Note that partial and full scholarships to Medicine X will be awarded.

    Partial scholarships reduce the registration fee to $199 in total for the three conference days. Full scholarships cover the entire registration amount.

    Separate financial assistance may be available for travel expenses and lodging costs.

  • Financial Need Assessment

    The following questions are such that the Medicine X ePatient Advisory Board may ascertain which ePatient scholarship applicants demonstrate financial need.
  • Certification of Application

  • PLEASE ENTER YOUR INITIALS ABOVE TO CERTIFY THIS FORM.

    The Medicine X ePatient Advisory Board recognizes that situations may suddenly change, and given adequate notice and reason, the Advisory Board will work with scholarship recipients to ensure recipients are able to attend the conference.

  • This field is for validation purposes and should be left unchanged.
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