2013 MDEA ENTRY QUESTIONNAIRE

For complete competition details, including eligibility requirements, rules, instructions, and to see past winners, visit the awards website at MDEAwards.com. Please follow these instructions and review the Entry Checklist and when compiling entries.

  1. Entrants should first review the EntryMaterials Checklist which provides a complete list of all required and recommended entry materials, as well as instructions on how to submit your entry materials. Review the checklist carefully, to supplement your submission with required Product Images, as well as recommended Additional Informative Visuals, Product Demo Videos for Jury Examination, and/or Sample Products for Jury Examination.
  1. Complete the Entry Questionnaire. Submitters should take care to answer each question clearly and fully, yet concisely. Focus your efforts on providing substantive information, and avoid unsubstantiated claims, comparisons with other products, and marketing hyperbole. Where necessary to answer specific questions, seek the assistance of others involved in developing your product (e.g., product engineer or designer to describe specific product features, or marketing executives to explain business benefitsetc.).
  • The total length of answers to questions 10 through 16 should not exceed seven single-spaced pages.
  • Leave no question blank. If you are not sure how to answer, please ask for guidance.
  • Entrants must provide their responses to this questionnaire in both electronic and hard-copy (signed) forms.
  • Entrants should not generate their own form. This Entry Questionnaire is provided as an unlocked Word document; when completed, it should be submitted in the same format.
  • Do not lock the document or convert it to a portable document format (PDF) file.
  • Do not alter the formatting of the questionnaire by changing type size or color or by resetting margins.
  1. Provide Supporting Documentation. Entrants are encouraged to support their responses to this questionnaire by providing additional documentation (e.g. exhibits, figures, appendices, studies, photographs, etc.). Appropriate supporting documents might include design specifications, product spec sheets, marketing brochures, measures of improved processing techniques, product test data, results of clinical medical studies, operating instructions and user manuals, copies of peer-reviewed articles about the product, patient/doctor testimonials, and so on.
  • Do not embed photos or other documents within the responses to this questionnaire. Instead, such materials should be referenced at the appropriate places in the responses to this questionnaire (e.g., see Figure 02; see Exhibit 04, see Image 05, etc.).
  • In the electronic form of the entry, such materials should be provided as separate files with clear file naming conventions(e.g., Productname_Figure_02; Productname_Exhibit_04; Productname_Image_05, etc.).
  • In the hard-copy form of the entry, such materials should be clearly numbered in the bottom margin (e.g., Figure 02; Exhibit 04, etc.)and placed in order at the end of the questionnaire.
  1. Submit Entry Materials. Entrants must submit each entry material item (e.g., Entry Questionnaire; product images; exhibits; figures, etc.) in both an electronic version, and a hard-copy version (to be used in your product folder for jury review).The Entry Instructions provide detailed information about the formatting of electronic files and hard copy materials. All videos MUST be submitted on PC-compatible CD-ROM or DVD format.
  • The electronic version of the completed Entry Questionnaire, together with other electronic materials pertaining to the entry, may be e-mailed to n emails smaller than 5MB each, oruploaded to our FTP site.
  • Alternatively, entrants may save the electronic form of their entry materials to a standard PC-compatible CD-ROM and mail them along with the hard-copy form of their entry. Please do not submit the same materials using multiple methods of delivery.
  • When completed, the signed hard-copy version of this entry form, together with other hard-copy entry materials, should be mailed to:

James Costigan

Medical Design Excellence Awards

UBM Canon

2901 28th Street, Suite 100

Santa Monica, CA 90405-2975 USA
Phone: 310-445-4266 | Fax: 310-445-4299 | Email:

PRODUCT AND ELIGIBILITY INFORMATION

1. Manufacturer Name.The manufacturer of record is the single corporate entity holding regulatory approval for marketing of the product.

2. Product Brand Name.Include generic descriptor after the product’s brand or trade name. Please note that all information must conform to UBM Canon’s press style. For this reason, we ask that you do not add copyright or trademark symbols.

3. Regulatory Approvals granted to the product (provide name of approving body, identification number, and date of issuance).Do not leave blank, or answer N/A. If exempt, or N/A, the submitter should provide information specifying why.

4. Date First Commercially Available.To be eligible for entry in the 2013 MDEA competition, all entered products must be commercially available—able to be ordered or purchased—by December 31, 2012.

5. Countries Where Commercially Available.

6. Dimensions and Weight.

7. Suggested Retail Price.Do not leave blank, or answer N/A. We understand your concern for confidentiality. However, a submitter must not leave a blank in response to any question, including this one. If you choose not to include the suggested price, some further explanation might be warranted. Please inquirefor possible examples.

8. Product Caption describing the product and its intended use. (Question 10 in the entry form will give you an opportunity to elaborate, but for this question please limit the caption to 255 characters maximum, including spaces. Please check using ‘Word Count’ feature.)

9. Select an Entry Category from the list below.

  • Entrants may choose only one category per entry.
  • Jurors may move an entry into a more appropriate category.
  • Jurors may select any number of finalists up to (but no more than) 6 finalists in each category.
  • From among the selected finalists, Jurors may award up to one Bronze, one Silver, or one Gold winner in each category. The jury will also award Best-in-Show to one Gold-winning product.
  • Although it is generally expected that there will be only one Bronze, one Silver, and one Gold winner in each category, this decision is left to the discretion of the MDEA Jury who may elect to present as many or as few awards as it deems merited by the quality and number of entries, irrespective of category.

_____ Critical-care and emergency medicine products

_____ Dental instruments, equipment, and supplies

_____ Finished medical packaging

_____ General hospital devices and therapeutic products

_____ Implant and tissue-replacement products

_____ In vitro diagnostics (biochemicals for diagnostic use, related instrumentation, and home-use devices)

_____ Over-the-counter and self-care products

_____ Radiological and electromechanical devices (diagnostic imaging devices, energy-emitting therapy devices)

_____ Rehabilitation and assistive-technology products (healthcare furnishings, patient-transfer equipment, and home-use medical equipment and supplies)

_____ Surgical equipment, instruments, and supplies

JUDGING INFORMATION

MDEA jurors will use responses to the following questions (and additional exhibits provided) to evaluate each entry. Leave no question blank. Answer each question fully and directly, referring to supporting documents as necessary. The total length of answers to questions 10 through 16 should not exceed seven single-spaced pages.

Provide Supporting Documentation(e.g., research reports, user studies, etc.) to support your findings.Do not embed photos or other documents within the responses to this questionnaire.

Instead, supporting documentation, such as figures, and other exhibits, should be referenced at the appropriate places in the responses to this questionnaire (e.g., see Figure 01; see Exhibit 04, etc.).In the electronic form of the entry, such materials should be provided as separate files with clear filenames (e.g., Productname_Figure_01; Productname_Exhibit_04, etc.). In the hard copy form of the entry, such materials should be clearly numbered in the bottom margin, and placed in order at the end of the questionnaire(e.g., Figure 01; Exhibit 04, etc.).

10. Product Overview. In a single paragraph, describe the product and its intended use. This paragraph is an elaboration of question 8. Product Caption, and should define what the product is, who should use it, the medical purposes of the product, and what settings it may be used in.

11. Materials and Components. What types of materials, components, and processes are used to fabricate the product? Be specific (e.g., polystyrene exterior case, EPROM circuitry, RS-232 communications ports, automated subsystem assembly, E-beam sterilization).

12. Technological Challenges. In relation to the clinical objectives of the product, describe the principal design and engineering challenges and how the product overcomes them. Pay particular attention to design and engineering innovations unique to this product. Why is this product better than what came before?

13. User-Related Features. In relation to actual use of the product, describe how the design and engineering features of this product reflect functional innovations that improve healthcare delivery. Pay particular attention to features that broaden the scope of users (e.g., turning a professional-use device into a home-use device), change traditional medical attitudes or practices, or offer significant use-related improvements (e.g., simplified training, easier use, intuitive user interfaces).

14. Patient Benefits. In relation to the clinical effectiveness of the product, describe how the design and engineering features of this product provide enhanced benefits to the patient (e.g., comfort, fit, service access, safety, appropriate aesthetics, overall improvement of healthcare). Provide documentation (e.g., research reports or user studies) to support your findings.

15. Company Benefits. Explain how the design and engineering aspects of the product improved the manufacturer’s profitability (e.g., reducing cost of development or manufacture, enhancing existing product lines, improving distribution, opening new market segments, increasing speed to market).

16. Benefits to the Healthcare System. Explain how the design and engineering aspects of the product improved the delivery of healthcare (e.g., making the device or related treatments more accessible to patients, improving safety or efficacy, increasing cost-effectiveness).

CONTACT INFORMATION

All submitter, manufacturer, and supplier main contacts should be sure to clear personal and company spam filters and other e-mail restrictions so that these individuals can receive e-mail messages from MDEA staff with addresses ending in “@ubm.com” and “@cancom.com”.

17. Submitter Contact. Provide full contact information for the individual who is responsible for the accuracy and completeness of this submission and will act as the contact for all correspondence throughout the competition, including submitting entry materials, any approvals, and notifications. Only one individual may be named. This contact may be a representative from the manufacturing company, a supplier company, or PR firm.

*All fields required except fax. Please do NOT type in ALL CAPS.

Submitter company *
Submitter contact first name *
Submitter contact last name *
Submitter contact job title *
Submitter address 1 *
Submitter address 2
Submitter city*
Submitter state*
Submitter zip*
Submitter country*
Submitter phone*
Submitter fax
Submitter e-mail*
Submitter company twitter handle / @

Has this company entered the MDEA program in previous years?

18. Submitter Authorization.The following statements must be authorized by the submitter’s electronic signature and date below:

  • I have determined that this product is commercially available—able to be ordered or purchased—now or will be by December 31, 2012.
  • I also attest to the accuracy of the information provided in this submission to the 2013 Medical Design Excellence Awards.

Submitter’s electronic signature(please type)*
Date *

*Both electronic signature and date are REQUIRED.

Note: All entry materials (including photos, graphics, and exhibits) must accurately represent the commercially available product and the submitter’s role in the in the design, engineering, manufacture, or distribution of the product. UBM Canon reserves the right to withhold or withdraw awards given for any product whose entry materials are later found to be inaccurate or misleading.

19. Manufacturer Contact. The manufacturer of record is the single corporate entity holding regulatory approval for the marketing of the product. Provide full contact information for an authorized representative of the manufacturer who has provided consent for this entry. If the submitting company is the same as the manufacturer, please write “same as submitter,” or you may list you may list a different key contact here for this company other than listed in the submitter section.

*All fields required except fax. Please do NOT type in ALL CAPS.

Manufacturer company*
Manufacturer contact first name *
Manufacturer contact last name *
Manufacturer contact job title *
Manufacturer address 1 *
Manufacturer address 2
Manufacturer city *
Manufacturer state *
Manufacturer zip *
Manufacturer country *
Manufacturer phone *
Manufacturer fax
Manufacturer e-mail *
Manufacturer companytwitter handle / @

Other team members employed by the manufacturer:
Note: Other team members may be contacted by editorial staff for story interviews ONLY in the hopeful event the product entered is selected as a finalist or winner.

NameTitle or rolePhoneE-mail

20. Design and Supply Credits.The adjunct MDEA Supplier Program is designed especially to acknowledge the contributions of supplier companies that provide goods, services, and support to MDEA-finalist and MDEA-winning products. The manufacturers of these award winning products often owe a large part of their success to the suppliers and designers who expertly assisted them along their development path. In fact, without the help of such outsourcing firms, many innovative products might never come to fruition. These companies are among the best in a wide-ranging vendor community—including design and engineering firms, materials suppliers, component manufacturers, consulting firms, or other contract services—all of whose efforts play a vital role in enabling medical device manufacturers to produce award-winning products.

Provide full contact information for one representative of each company that contributed significantly to the development of this product. If the submitting company is the also a supplier, please include again in this section.

(Copy and paste the lines below as required for each contributing supplier company).

*All fields required except fax. Please do NOT type in ALL CAPS.

Supplier company *
Supplier contact first name *
Supplier contact last name *
Supplier contact job title *
Supplier address 1 *
Supplier address 2
Supplier city *
Supplier state *
Supplier zip *
Supplier country *
Supplier phone *
Supplier fax
Supplier e-mail *
Supplier company twitter handle / @

Other team members employed by this company:

Note: Other team members may be contacted by editorial staff for story interviews ONLY in the hopeful event the product entered is selected as a finalist or winner.

NameTitle or rolePhoneE-mail

/ Deadlines and Entry Fees for the 2013 MDEA competition are as follows:
Note:Entry fees differ according to the date by which the entry is submitted.
Early-bird deadline: / November 9, 2012 / $400
Standard deadline: / December 7, 2012 / $600
Final deadline: / January 11, 2013 / $700

ENTRY FEE PAYMENT

21. Declare form of payment.(Select one)

a. Check___
or /

If the entry fee will be paid bycheck, please write 2013 MDEA Entry Fee+ the name of the product being entered into the memo field, and include the check with this page in the hard-copy portion of your entry that is mailed. All check and money order payments must be made in U.S. funds drawn on a U.S. bank. Make checks payable to UBM Canon LLC.

b. Credit card___ / If the entry fee will be paid with a credit card, please type the following information, and thenprint this page, sign, and date. Either include this completed page with hard copy submission OR fax to 310-445-4299. You can email o confirm fax was received.Please do not email or include the actual credit card number in the electronic version of the entry form.
*All fields required. Please type responses in the spaces provided.
*Name of product entered:
*Amount:(in $US dollars) / $
____Visa ____MasterCard ____ American Express
* Account number:
*Expiration date:
*Security Code: / (Last 3/4 digits on back of card)
* Name of cardholder:
(as appears on card)
* Billing Address:
* Phone Number:
(for processing issues)
* e-Mail (required for receipt:
For internal purposes: / Code to Acct# 86-550-5830-20202-1306-000-R-00

I herewith authorize UBM LLC to charge my above listed credit card.

Cardholder’s signature X:*
Date *

Note:Entry fees are not refundable under any circumstances. Entrants are responsible for payment of all fees related to the delivery of their entry materials and sample products, including customs tariffs, brokerage charges, and other shipping costs. Delivery-related invoices received by UBM Canon will be forwarded to the submitter for payment.

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