Community Clinic Association of Los Angeles County

2023 Health IT Summit Session Submission Form

2023 Annual Health IT Summit Session Submission Form

Sessions are to be 50 minutes in duration. The deadline for submission is June 16, 2023. You may stop and return to the application at any time by saving and using the unique link provided. Please email Traci Bivens-Davis, CCALAC Assistant Director of Training and Equity with any questions about the Summit sessions at tbivens@ccalac.org.

Submission Contact
Name*
First Last
Title*
Company
Address
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Presenter Information
Is presenter contact information the same as above?*
- Yes
- No
Please provide your educational and professional information as you want listed. Include any professional credentials and designations.*
Name and Title*
Company
Address
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Please provide a brief biography to be included in Summit materials. (500 character maximum)*
Presentation/Training Expertise
Presentation/Training Expertise*
Qualifications Present on Topic*
Please list the name, organization and contact information for a reference we can contact regarding your presentation experience.*
Is there more than one presenter?
- Yes
- No
Total Number of Presenters
- Two (2)
- Three (3)
Maximum of three presenters. Please contact Traci Bivens-Davis with questions at tbivens@ccalac.org
Name of Presenter 1*
First Last
Title of Presenter 1*
Company of Presenter 1*
Phone Number of Presenter 1*
Email of Presenter 1*
Please provide your educational and professional information as you want listed. Include any professional credentials and designations.*
Please provide a brief biography to be included in Summit materials. (500 character maximum)*
Presentation/Training Expertise of Presenter 1*
Qualifications of Presenter 1 to Present on Topic*
Presenter 1: Please list the name, organization and contact information for a reference we can contact regarding your presentation experience.*
Name of Presenter 2*
First Last
Title of Presenter 2*
Company of Presenter 2*
Phone Number of Presenter 2*
Email of Presenter 2*
Please provide your educational and professional information as you want listed. Include any professional credentials and designations.*
Please provide a brief biography to be included in Summit materials. (500 character maximum)*
Presentation/Training Expertise of Presenter 2*
Qualifications of Presenter 2 to Present on Topic*
Presenter 2: Please list the name, organization and contact information for a reference we can contact regarding your presentation experience.*
Name of Presenter 3*
First Last
Title of Presenter 3*
Company of Presenter 3*
Phone Number of Presenter 3*
Email of Presenter 3*
Please provide your educational and professional information as you want listed. Include any professional credentials and designations.*
Please provide a brief biography to be included in Summit materials. (500 character maximum)*
Presentation/Training Expertise of Presenter 3*
Qualifications of Presenter 3 to Present on Topic*
Presenter 3: Please list the name, organization and contact information for a reference we can contact regarding your presentation experience.*
If more than one presenter: Have presenters presented together before?*
- Yes
- No
Please upload headshots here for ALL PRESENTERS. The minimum required specs for the headshot(s) are 300 dpi.*
Drop files here or
Max. file size: 16 MB.
Session Information
Sessions are 50 minutes in duration.
What content area does your session cover?*
- Interoperability/Data Exchange (HIE, data exchange framework, information blocking, etc.)
- Digital divide (addressing the digital divide, digital navigator programs, etc.)
- AI/Machine Learning Healthcare Technology
- CalAIM and PHMI Technology Implementation and Insights
- Cybersecurity (establishing awareness programs, breach remediation experience, etc.)
- Data Analytics and Reporting (UDS+ preparedness, etc.)
- Other
Check all that apply.
If you have a great idea for a session that does not fall into one of these categories, please submit your idea! Please briefly explain the content area your session will address and how it aligns with the mission of the 4th Annual Health IT Summit.
Please describe how your session aligns with the mission of the 3rd Annual Health IT Summit below:
Session
Session Title*
Session Description*
List 3-5 Learning Objectives:*
How will these objectives be met?*
Level of content to be presented?*
- Basic
- Intermediate
- Advanced
Who is the target audience for this session?*
By clicking here, I consent to CCALAC using the biography, professional designations, and headshot I provide, if chosen, in event marketing and on the Annual Health IT Summit agenda. CCALAC will contact speakers with any revisions or suggested amendments to session title or content.*
I consent.

Community Clinic Association of Los Angeles County
445 South Figueroa Street Suite 2100, Los Angeles, CA 90071
(213) 201-6500

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Community Clinic Association of Los Angeles County

2023 Annual Health IT Summit Session Submission Form

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Presenter Information

Presentation/Training Expertise

Session Information

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