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. / NAME
2. / FACULTY/EMPLOYER
3. /
DEPARTMENT
4. / EMPLOYER’S ADDRESS
5. / 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 / University

18.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 / Signature

DISCLOSURE 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 / Signature

Senior Alberta Health Services Administrator

Name & Title: ______

Signature: ______

Date: ______

Alberta Health Services, SVP, Research Innovation and Analytics

Name: ______

Signature: ______

Date: ______

AHS April2014