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Intellectual Asset Management

Forms

To assist potential inventors at Intermountain we have prepared various forms to help you and Intermountain protect and license potential inventions or discoveries.

Invention Disclosures
Non-Disclosure Form
Material Transfer Agreement Forms

NOTE: Each form is a fillable Word document; please download and save the document to your desktop before filling out the form's fields.

Invention Disclosures
When a new invention or software is conceived, the inventor should complete an Invention Disclosure form and forward the disclosure to the IAM office. There are two types of invention disclosure forms: 1) an invention disclosure form specifically for software, and; 2) another form for all other types of inventions (e.g., new devices or improvement to devices, diagnostic tests or therapeutics uses for drugs, medical equipment or instruments).

Please complete and sign the appropriate invention disclosure form, and provide an original signed copy to IAM:

Non-Disclosure Form
Non-Disclosure Agreements (also referred to as Confidential Disclosure Agreements) should be put in place when a physician, investigator or other employee at Intermountain wishes to share ANY proprietary information, written or spoken, with another organization, particularly a for-profit entity. Without a Non-Disclosure Agreement, the recipient of the disclosed information could use or distribute Intermountain and the Intermountain employee's information for any purpose without permission or approval by IHC or the employee.

Please complete the Non-Disclosure Form provided, and we will gladly prepare a Non-Disclosure Agreement for you, signed by the appropriate authorized IHC representative:

Non-Disclosure Form

Material Transfer Agreement Forms
If you wish to receive or provide to another organization certain materials, it is important that a Material Transfer Agreement be put in place, particularly when a for-profit entity is interested in receiving or providing materials for research purposes. Materials may include tangible materials (e.g., antibodies, blood samples, cell lines, DNA, plasma samples, prototypes of medical devices or instruments), or intangible materials (e.g., data, software, source code, or human sample sets).

HUMAN SAMPLE MATERIAL
If your research includes the collection and use of human sample sets, and you plan to transfer these samples to another location outside of Intermountain, IAM should prepare a specific type of Material Transfer Agreement related to the transfer of such. In this case, you will need to complete an Intermountain Human Sample Material Transfer Form for IAM to prepare the Material Transfer Agreement and have the appropriate authorized Intermountain representative sign the agreement.

Intermountain Human Sample Material Transfer Form

NOTE: In the event another institution or company investigator desires to receive human samples, and/or protected patient information, the requesting institution or company will also be required to sign a Business Associates Agreement to provide assurance that they will comply with Intermountain and HIPAA policies regarding the use of such human samples and/or medical information. Please contact Intermountain's Corporate Compliance office at (801) 442-5686 to get further information about Business Associates Agreements or a copy of the agreement.

NON-HUMAN SAMPLE MATERAL
If your research includes the transfer of other types of materials that are NOT human samples, and you plan to transfer such materials to another location outside of Intermountain, IAM can prepare a Non-Human Sample Material Transfer Agreement. In this instance, you will need to complete an Intermountain Non-Human Sample Material Transfer Form for IAM to prepare the Non-Human Sample Material Transfer Agreement and have the appropriate authorized Intermountain representative sign the agreement:

Intermountain Non-Human Sample Material Transfer Form

NOTE: If you request materials from a company or institution and receive a Material Transfer Agreement, it should be sent to IAM or the Office of Research for review and approval. We will also have the appropriate authorized representative of Intermountain sign the agreement.

Please contact IAM if you have a question about Invention Disclosure forms, Non-Disclosure Agreements, or Material Transfer Agreements.