Neehr Perfect CPRS Content Request Form

Complete this form onlyif you have patient charts or documentation templates currently in Neehr Perfect CPRS that you are requesting to be published in Neehr Perfect Go! Complete one form for each patient chart or template submitted and send as an attachment in an email to .

Your Contact Information

Your Name:

Your Position and Department:

Your School:

Your email:

The best phone number to reach you at if we have a question:

Patient Chart

We have a patient chart in Neehr Perfect CPRS that we want published inGo!

Chart Name:

Chart SS#:

Chart DOB:

Edits that need to be made to the chart data:

Chart summary or overview, i.e. clinical story:

Educational objectives met through use of this chart:

Any other unique features of chart:

Documentation Template

We have a documentation template in Neehr Perfect CPRS that we want published inGo!

Template Title/Name:

Edits that need to be made to the template:

Educational objectives met through use of this template:

Any other unique features of template:

Acknowledge for Submission:

ARCHETYPE INNOVATIONS’ NEEHR PERFECT ASSIGNMENT AGREEMENT

By submitting your content to Neehr Perfect via , you are acknowledging and accepting the following. Do not submit content that you do not have rights to assign to Neehr Perfect per this agreement.

THIS ASSIGNMENT AGREEMENT, is entered into by and between the author and copyright owner named below (“Assignor”) and Archetype Innovations, LLC ("Assignee").

FOR GOOD AND VALUABLE CONSIDERATION, the receipt and sufficiency of which are hereby acknowledged, Assignor and Archetype agree as follows:

1. Assignor does hereby assign, sell, transfer, set over and deliver unto Assignee all of its right, title and interest in and to the following copyrighted materials listed in Exhibit A attached hereto and incorporated by reference herein (hereinafter, the “Materials”).

2. Assignor represents and warrants that Assignor is the creator of the Materials and is the sole the owner of all intellectual property rights in the Materials, including but not limited to all registered, unregistered, statutory and common law copyrights. Assignor further represents that Assignor is not prohibited, prevented, or otherwise restricted by law, contract, or any other means, from freely and voluntarily assigning to Assignee all of Assignor’s right, title and interest in and to the Materials.

3. Assignor agrees that Assignor will, any time and from time to time, upon receipt of written request, execute and deliver to Assignee, including its successors and assigns, any new or confirmatory instruments which may be necessary in order to protect or fully assign and transfer to and vest in Assignee, and/or its successors and assigns, its right, title, and interest in and to the Materials.

4. Assignee agrees that it will give Assignor credit for being the original author of the Materials in any publication, licensing, display, distribution or other use of the Materials, including but not limited to use of the Materials in connection with any of Assignee’s copyrighted software products.

5. This Agreement sets forth the entire agreement of the parties with respect to the assignment of the Materials, superseding all prior agreements and understandings, and may be amended only in writing. All notices shall be in writing and given to a party at the address set forth in this Neehr Perfect Content Submission. This Agreement shall be governed by and construed in accordance with the laws of the state of Minnesota, without giving effect to the conflict of laws principles thereof. This Agreement shall be binding upon and inure to the benefit of the successors and assignees of Assignor and Assignee.

Thank you for your submission! We are always open to new educational content to benefit healthcare education and individual faculty and students. Your submission assists us in helping educators to teach and prepare the next generation of healthcare professionals.

It is our policy to review and consider all requests for a chart, or a request for edit in a current chart. You will receive an email from us advising you of the status of your submission on the next of the following dates: February 15th, June 15th, or October 15th. Best of luck!

Neehr Perfect Go! Content submission form – for CPRS content