ALBERTAHealth Services
REPORT OF INVENTION
FORM FOR IP DISCLOSURES
ALBERTA Health Services
REPORT OF INVENTION OR IP DISCLOSURES - INTRODUCTION
Purpose of the Report of Invention or IP Disclosures
1.The purpose of completing an IP disclosure (ROI) is to provide a record and information repository to provide evidentiary support and information for administrative purposes as per AHS IP Policy and Procedures Manual in protecting the IP rights and interest of the inventors and AHS and in conducting a literature/IP search.
2.There are no “Patent Application Forms”. An agent must prepare an application in the format required by the Federal Government. Patent agents need specific information to carry out their assignment and the Report of Invention is their principal source of information.
3.The Report of Invention also provides information used to administer the AHSIP Policy and Procedures.
Structure of the Report of Invention
1.The information on the form is grouped under the following headings:
a.Personal Datag.General Explanation
b.Title of Inventionh.Use
c.Patent Policy Administrationi.Marketing
d.Description of Inventionj.Publication
e.Type of Inventionk.Disclosure and Authorization
f.Background Informationl.Comments on the Invention
2.The headings are for the most part self-explanatory; however, the following should be noted with respect to the Description of Invention.
For Chemical Invention
When the invention lies in a formulation, mixture of ingredients or a chemical procedure involving quantities or proportions, please set out the expected workable ranges for the various ingredients. Preferably, the ranges should be supported by test data, and such data should be included as an appendix. If no test data are available, then try to estimate the workable ranges of the various components. The patent agent will typically have to devise monopoly claims expressed in terms of percentage or proportion ranges. If the expressed ranges are too narrow, competitors might be able to circumvent the patent by narrowly avoiding the claimed ranges. On the other hand, if the ranges are so broad as to include unworkable mixtures, the patent could be attacked on this basis.
For Computer-related Invention
Computer-related inventions can be patentable provided the computer, when programmed, interacts with the real world in some way. Generally, there must be some interfacing with real things in order to obtain protection under current patent law. Thus, a system for regulating the operation of air-blowers in a sewage treatment plant, in which a computer performs calculations based on oxygen levels in the sewage taken should be patentable (prior art permitting). Computer-related patent applications should be accompanied by at least a logic flow diagram explaining the various stages followed by the computing process. Preferably, a printout of the program itself should also be included. Software cannot be patented. Protection for this intellectual property is covered by copyright.
ALBERTAHealth Services
REPORT OF INVENTION
Personal Information
1. / NAME2. / FACULTY/EMPLOYER
3. /
DEPARTMENT
4. / EMPLOYER’S ADDRESS5. / BUSINESS TELEPHONE
6. /
ADDRESS/RESIDENCE
7. /TELEPHONE/RESIDENCE
8. /CANADIAN CITIZEN
9. /LANDED IMMIGRANT
10. /OTHER NATIONALITY
(PLEASE SPECIFY)11.TITLE OF INVENTION
PATENT POLICY ADMINISTRATION
12.Was the invention made as a result of research wholly financed by the Alberta Health Services? ____ Yes ____ No. If the invention was made as a result of research financed by an organization other than the Alberta Health Services, please complete the following sections.
13.Title of Grant, Contract or Award (s)
14.Sponsoring Organization(s)
15.Summary of Research Proposal(s)
16.Amount of Award(s)Date of Award(s)
17.Project Participants:
Name
/ Title / Department / University18.My application for a patent will be made:
______Under the Alberta Health Services’ Patent Plan
______Under the terms of a sponsored research program (grant, contract orAgreement)
______As an individual, independent of the AHS, if approved by the AHS
As applicable, please specify the grant, terms or clauses of the contract or agreementconcerning ownership of patent rights that exempt you from applying under the AlbertaHealth Services’ Patent Plan:
DESCRIPTION OF INVENTION
19.Describe your invention. You should fully describe those aspects of the invention that are responsible for any technological advances, improved functions or uniqueness. Please refer to and attach appropriate drawings/sketches, photographs, graphs or any other supporting documentation that helps to describe and explain your invention. If your invention is a chemical invention or computer related, please refer to the explanatory notes before completing this section.
This description includes ____ additional pages entitled “19 Continued”.
TYPE OF INVENTION
20.Is your invention a:____ device
____ product
____ process
____ chemical compound
____ new use of an existing product or process
____ other (specify)
BACKGROUND INFORMATION
21.Provide sufficient information concerning the field in which the discovery was made so that the reader will be able to appreciate the importance of your invention. Discuss any prior developments.
GENERAL INFORMATION
22.What needs does your invention satisfy: what problem(s) does it solve?
23.How have these needs/problems been addressed until now?
24.What are the limitations or drawbacks or current devices, products or processes?
25.How does your invention solve these problems or overcome these limitations?
26.Why is your invention novel?
27.What key words describe your invention (use all key words including alternative descriptions. These will be used for a computer search).
28.Describe any alternatives or variations:
29.Have you tested your invention, produced any prototypes? Please give details.
30.Describe any improvements or modifications you are considering:
USE
31.An invention, to be patentable, must have practical application to industry, trade or commerce. It must be useful in some way. This usefulness can be expressed in economic terms, such as increased efficiency, or simply something that previously could not be accomplished at all. What practical applications or useful features does your invention offer?
MARKETING
32.Who would be interested in marketing your product?
33.Have you contacted anyone with respect to licensing or marketing your invention?
____ No ____ Yes Give details:
PUBLICATIONS
34.Describe relevant publications or similar patents, and if possible, comment on their shortcomings:
35.Have you “published” your invention in whole or in part, in writing, by a speech, talk, lecture, seminar or by any other means? ____ Yes ____ No If yes, please give details as to the degree of your disclosure; when, where, and to whom:
36.Do you intend to publish details of your invention, in whole or in part? ____ Yes ____ No If yes, give details as to what you intend to disclose, when, where and to whom:
37.If an inventor(s) has an appointment/position with another organization (e.g. university, company, etc) specify the nature of this appointment/position, and the source and amount of any related funding.
CO-INVENTORS’ RELATIVE CONTRIBUTION
38.In cases where there are co-inventors, list the relative contribution (must total 100%) of each inventor to the invention. Net revenue apportionment of the IP Creators’ share shall be distributed according to this relative contribution.
If the research and related development involving some or all of the co-inventors are not yet completed, the final relative contributions of the co-inventors may vary.
Name
/ Title / Relative Contribution%
%
%
COMMENTS
39.Please use this space for any additional comments you may wish to make:
NOTIFICATION OF THE INVENTION
40.Confirmation from the Inventor(s) Supervisor, Department Head, Dean, or other reporting officers that he/ she has reviewed the Invention Report and acknowledges that information contained herein is confidential:
The Inventor(s) acknowledges that this completed form may be shared under applicable intellectual property agreements and strict non-disclosure provisions with universities, other educational, and/or research institutions where the Inventor(s)holds a joint appointment.
Date
/ Name / Title / SignatureDISCLOSURE AND AUTHORIZATION (To be completed by all inventors.)
41.I understand that if this is accepted by the Patent Committee in accordance with the Alberta Health Services’ Patent Policy if applicable, the Alberta Health Services is authorized to disclose to third parties details of this invention for the purpose of securing patent protection or royalties from commercial exploitation. Please sign this section to complete the Report of Invention.
Date
/ Name / Title / SignatureSenior Alberta Health Services Administrator
Name & Title: ______
Signature: ______
Date: ______
Alberta Health Services, SVP, Research Innovation and Analytics
Name: ______
Signature: ______
Date: ______
AHS April2014