Instructions for the Invention Disclosure Form

Following is a description of each section of the Invention Disclosure Form:

Section 1: The Invention

Title of invention. Please note that this does not necessarily need to be the final title on the patent application.

Section 2: Inventors

Give the following information for each inventor:

  • Full name
  • Official title or position at Northwell Health or other institution.
  • Broad contribution to the invention.

Note: Inventorship is a concept that has a strict legal definition; if there is any doubt whether a given person qualifies as an inventor, then it is best to include that person’s name on the disclosure and our patent attorneys will make the final determination of inventorship.

Section 3: Contribution of Northwell Health to the Invention

Give details about personnel, money, materials, or other resources used.

Section 4: Contributions of other Organizations, including Granting Agencies

  • List personnel, money, facilities, or materials.
  • If this work was supported by a grant or contract, indicate the funding agency and grant number. This information is very important as the Office of Technology Transfer has an obligation to report any and all inventions which result from government grant support. For more information see: https://s-edison.info.nih.gov/iEdison/37CFR401.jsp
  • If material was obtained under the terms of a material transfer agreement (MTA), give details including company or university scientist and date of agreement.

Section 5: Description of Invention

Sketches, prints, photos, block diagrams and any pertinent manuscript should be attached to this disclosure. Manuscripts generally following this outline are acceptable substitutes.

  • General purpose. State in general terms the purpose and object of the invention.
  • Background. Describe the prior art (identify by patent number or journal citation, if possible), and its disadvantages or shortcomings; indicate how the invention overcomes these disadvantages and shortcomings.
  • Description and operation. Describe completely the construction or operation of the invention using reference characters to identify components or steps in attached illustrations. Give a description of one complete operational cycle, if applicable. Identify any critical component or step. Specify broad and preferred ranges for all variables.
  • Composition of Matter. If the invention relates to the synthesis or identification of a new composition of matter, describe the product in structural form, if possible, and the process of making it. Include all available information regarding its physical characteristics and all test data evidencing its utility.
  • Prototypes, Samples or Preliminary Data. Do you have information or data to demonstrate the invention?
  • Advantages of the Invention. Specify.
  • Disadvantages of the Invention. Specify.

Section 6: Documentation

  • When did you first think of the invention? Did you document it by text, sketch, drawing or the like in a notebook or dated record?
  • When did you first reduce the invention to practice? Did you document it by text, sketch, drawing or the like in a notebook or a dated record?

Section 7: Commercial Possibilities

Discuss potential commercial applications of this invention. Information about the market size and pricing of comparable technologies would be especially useful.

Section 8: Commercial Contacts

List companies or company representatives with whom you have discussed this invention; attach copies of any correspondence relating to this invention. Give dates and nature of any conversations related to this invention.

Section 9: Publications or Presentations

Indicate whether the invention has been or will be described in ANY of the following ways:

  • A published paper
  • A paper that has been submitted for publication
  • An oral presentation at a meeting, including the meeting date and location
  • A poster presentation at a meeting
  • An abstract submitted for presentation

Please attach a copy of the publication, preprint, or abstract. Also include the expected public disclosure of the information.

Section 10: Execution of Disclosure

The disclosure should be signed and dated by the inventor(s).

Section 11: Witness

The disclosure should be read and signed by at least one technically qualified witness who has read and understood it.