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Health Technology Assessment Application

This question requires a valid date format of MM/DD/YYYY.
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2. GENERAL INFORMATION *This question is required.
This question requires a valid email address.
DESCRIPTION OF THE TECHNOLOGY
9. Is this technology licensed by Health Canada?
If No, please contact us to discuss before submitting this application.
Space Cell
13. To your knowledge, has this technology previously been reviewed by Health Quality Ontario? Please check Reports and Recommendations for previous evidence reviews.
14. Is this technology being used in Ontario?
15. Is this technology being used in other Canadian provinces and/or other countries?
ADDITIONAL MATERIALS
16. If you have relevant information concerning the benefit of the technology, equipment, technique, or treatment strategy, please include it with your application.
This evidence may include, for example, published clinical research or economic evaluations, patient or doctor experience/interviews, and/or manufacturer information. To include a hyperlink as part of your submission, paste it into a Word document and upload the document.
If you have any concerns regarding the collection or management of your personal information, please consult Health Quality Ontario’s privacy policy. For any additional questions, please contact Health Quality Ontario’s Chief Privacy Officer by emailing privacy@hqontario.ca.