GE-Everyday Genius Insights-Form

* Required fields

• Does the idea take your team, your department, or your hospital to a new level of patient care, social responsibility,
or business success?
• Is the idea such a good solution, your colleagues will ask “why didn’t we think of that”?
• Does the idea turn a problem into an opportunity?

If you answered “yes,” it’s an Everyday Genius Insight. Please submit it below.

There are 3 ways to share your insight:
• This online form.
• Email this completed form to Everyday.genius@ge.com. You can download it here.
• You can upload your form here.
• Give this completed form to your GE OEC representative.

1. What is the insight? Describe the problem and how the insight is solving that problem. *This question is required.

2. What have been/or could be the impacts on your organization/community/patient? *This question is required.

3. What or who was critical to your success? *This question is required.

4. If there are next steps or more work to be done please describe.

5. If your Insight involves GE products or resources please describe that involvement.

6. What best categorizes the insight: (check all that apply) *This question is required.

NAME

ORGANIZATION

EMAIL This question requires a valid email address.

PHONE This question requires a valid number format.

As the facility representative I give permission for GE Healthcare to use the name of our Facility in their marketing materials.

PRINT NAME AND TITLE SIGNATURE AND DATE

I agree that GE can use my submission to help promote Everyday Genius. I understand the Terms and Conditions as listed at: www.gehealthcare.com/everydaygeniusTC

I further agree that GE Healthcare Surgery has my permission to email me
more information on the EveryDay Genius and similar programs. *This question is required.

SIGNATURE

Clear

Signature of

Disclaimer:

Facility gives GE Healthcare permission to use their insight, name, likeness and facility name (if signed by the facility) to promote and market Everyday Genius and associated GE Healthcare products.
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