OMI ATIO FORM: (Kindly fill in the following details.

Attach additional sheets wherever required)

Award ominated For

(Please tick only O E sub category) : Institutional Category

Best multidisciplinary healthcare delivery centre/organization Best multidisciplinary healthcare educational institution Best research and innovation Best prevention & awareness campaign Best rehabilitation & Community integration

Individual Category
Outstanding Individual achievement by a Professional Outstanding individual achievement in Non profit work Outstanding individual achievement as Entrepreneur

Lifetime achievement award

Significant contribution to the profession

DETAILS OF NOMINEE Full Name Date of Birth Designation & Institution Educational Qualifications Complete Postal Address : : : : :

Attach recent passport size Photograph (In white or grey background)

Telephone Number ( With STD code) - Office/Institution : Residence/Mobile : : :

Fax Website & Email(s)

Details of Current Work (Please attach separate sheet, if necessary)

Details of Previous Work/ Employment (If Applicable):

Detailed Description of Achievement:

Rationale For Nomination

Describe what makes the nominee appropriate for this award. Please describe the ominee's path towards achievement, the difficulties, the struggles to achieve and the uniqueness/novelty of the service established. (Please attach separate sheet, if necessary)

Describe the impact of the Nominees work on others in society:

Details of Grants in Aid that the Nominee has received with regard to work:

IV. DETAILS OF NOMINATOR

Full Name of the Nominator : Registration Number(conference/workshop) : Complete Postal Address of Nominator : Telephone Number (with STD code) : Email :

V. DETAILS OF ENDORSERS (Endorsers will authenticate the details given in the nomination)
Endorser/Reference 1 Full Name of the Endorsers Complete Postal Address Endorser/Reference 2

Telephone Number(with STD code) Fax E-mail

:
Date: Place:

Signature of ominee: Signature of ominator:

( ote: Please attach any other work-related photographs, copies of certificates & other relevant documents-Xeroxed and attested copies)

DECLARATIO
I, ........................................ (Nominee Name) hereby declare that I am willing to accept the prestigious ICMH- AIIMS 2014 award, if selected. Place: Date: Signature:

Disclaimer: Materials that accompany the application forms WILL OT be returned. Incomplete form, inappropriate information will disqualify the entry automatically. Decision of jury is the final decision. Disputes of any kind related to awards will not be entertained. Further queries: icmhaiims2014@gmail.com

Attention Psychology Fraternity!

Call for speakers & Scientific Papers
International Conference on Multidisciplinary Healthcare, AIIMS 2014
9-14th January 2014 Psychology & Mental Health Workshop Tentative Topics for Psychology Desciplines Psychological interventions for Pain Management (Clinical, Neuro, Child, de-addiction) Code: Psy 01, Fee: Rs.800/- Date: 9 Jan.2014 ICMHAIIMS2014 Prof. Manju Mehta, Deptt. Of Psychiatry, AIIMS
th

Clinical Neuropsychology Clinical Neuropsychological assessment in different neurological conditions Interpretation of neuropsychological tests Neuropsychology treatment and Rehabilitation approaches for neurological conditions Child and adolescence Child and adolescence Multidisciplinary health approaches Autism: Early intervention in neurodevelopmental disability Life skill and spirituality, I.Q assessment, Emotional & spiritual Intelligence Eating Disorders and emotional disturbances and obesity Cognitive Science and Application Cognitive behaviour therapy (CBT) & its Application in depression, anxiety & Cognitive disorders and management Imagery techniques and Clinical application Neuropsychological Rehabilitation & Cognitive Retraining Addiction and De-addiction Modern de-addiction technique and Psychological therapeutic therapies used for substance abuse,Internet addiction & Facebook addiction Chronic pain management Psychological factors in chronic illness and pain Counselling the terminally ill patient Psychological aspects of Geriatric care Assessment & Specialized test for elderly Psychological disorders Aggression management in therapies Mood disorders and treatment Schizophrenia: clinical picture and dynamics Types of Psycho Therapies and application Model & framework of psychological therapies & application Counselling Psychology Counselling theories, technique and application Personality and Self Projective evaluation in personality assessment Personality disorder & Psychological treatment Post-traumatic stress disorder Children and violence Sexually abused and rape & War victims Criminal & Forensic Psychology Assessment, Evaluation & Testing

Psychological interventions in medical settings

Code: Psy 02, Fee: Rs.800/- Date: 9th Jan.2014 Asst.Prof. Rachna Bhargav, Deptt. NDDTC, AIIMS Prof. Priti Arun, Deptt. GMC, Chandigarh

Neuropsychological Assessment
Code: Psy 03, Fee: Rs.2000/- Date: 10 Jan.2014 Assc. Prof. Ashima Nehra , AIIMS Addl. Prof. Jamuna Rajeshwaran, NIMHANS, Bangalore Addl. Prof. Keshav Kumar, NIMHANS, Bangalore
th

Cognitive Behaviour Therapy (Basic and Beyond)

Code: Psy 04, Fee: Rs.4000/-Date: 9th to 10th Jan.2014 Asst. Prof. Nimisha Kumar, CECDR, Jamia Millia Islamia Psychosocial Assessment and Interventions for Children Code: Psy 05, Fee: Rs.800/- Date: 9th Jan.2014 (1.30 P.M to 5.30 P.M), Asst. Prof. Sujata Satapathy, Dept. of Psychiatry, AIIMS Asst. Prof. Subhasis Bhadra, Dept. of PSW, Gautam Budhh University, Greater Noida

Neuropsychological Rehabilitation
Code: Psy 06, Fee: Rs.2000/- Date: 13 Jan.2014 Assc. Prof. Ashima Nehra , AIIMS, Jamuna Rajeshwaran, NIMHANS, Addl. Prof. Keshav Kumar , NIMHANS
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Past Life Regression Therapy

Code: Psy 07, Fee: Rs.4000/- Date: 13 to 14 Jan.2014 Dr. Newton Kondaveti, M.D. & Dr.Lakshmi, M.B.B.S. Life Research Academy, Hydrabad
th th

Psychological interventions for Autistic Disorder

Code: Psy 08, Fee: Rs.800/- Date:14 Jan.2014 Dr. Savita Sapra(Senior Scientist) & Addl. Prof. Sheffali Gulati, Pediatrics, AIIMS
th

Identification and management of Substance Use

Code: Psy 09, Fee: Rs.800/- Date: 14 Jan.2014 Asst.Prof. Gauri Shankar Kalaioya, Deptt. NDDTC, AIIMS
th

Tentative Free Symposium, CME and Seminars

Quality of life and positive mental health Psycho- analysis for Clinical Psychologist National policy on Geriatric Psycology and aging Evaluation and rehabilitation of the sexually abused Applications of 'Indian' concepts of mental health Management of substance used disorders: Psychological approaches 7. Basic Psychotherapeutic skills for health care professional

1. 2. 3. 4. 5. 6.

Download
Registration Form Student Event Form Award Nomination Form www.icmhaiims.com & www.aiims.edu

Psychology Partner
(workshop sponsor)

Attractions of the Conference Best Nati onal/International Scientific Lectures/ Pa pers Honors & Awards for significant work Competitive Student Events

REGISTRATION FORM
Pre-Conference: 9-10th Jan 2014 Conference: 11-12th Jan 2014 Post-Conference: 13-14th Jan 2014

(Please fill in block letters) Name of Delegate:AgeSex Qualifications: .Institute & University Address for correspondence. . StatePin code. Mobile Telephone (with STD code): OfficeResidence. Email I.D..

Conference Registration Fee Details

Categories UPTO Early Bird: till 15th Nov 2013 Advance: 15th Nov. to 10th Jan. 2014 Spot : India & SAARC Country Delegates Rs. 2500 (INR) Rs. 3000 (INR) Rs. 3500 (INR) Other Countries Students Rs.2000 (INR) Rs.2500 (INR) Rs.3000 (INR) Delegates 100 USD 150 USD 200 USD

Workshop Registration Details

Please refer to Brochure/Website www.icmhaiims.com, www.aiims.edu for workshop code and fee details Workshop Code Workshop Fee PRECON Code (9th to 10th Jan 2014) POSTCON Code (13th to 14th Jan 2014)

Payment Detail: (Please include Rs. 50/- extra while paying through outstation cheques) All Payments shall be made by cash/Local or At Par Cheque (multicity cheques)/demand draft favouring ICMHAIIMS 2014payable at SBI Ansari Nagar Branch, New Delhi-29. Note: For online/direct money transfer through any bank service window (Internet Banking): Use National Delegates Code no. (SBI-N000 1536, IFSC) & International Delegates Code No. (SBI NINBB545 Swift), along with SBI Ansari Nagar Bank Account No. 32918099603 Program DD/Cheque No. with Bank and Branch Details Amount Payment mode
Conf. Registration Fee Workshop Fee Total For Secretarial use Only Date Registration no. Code Remark Treasurer

Cash Demand Draft Local & at Par Cheques

CALL FOR ABSTRACTS/POSTER International Conference on Multidisciplinary Healthcare AIIMS 2014

There are two different presentation formats for abstracts /paper submission which have equal standing in the programme, they are listed below. PLATFORM PRESENTATIONS A platform presentation should be for 10 minute oral presentation of a paper and followed by 3 minutes of question time, moderated by a chair. Papers will be grouped together around related topics and there will be approximately 6 papers per session. Sessions will up to hours. POSTER PRESENTATIONS Posters are reports summarizing information using brief written statements and graphic materials, such as graphs, charts, figures and photographs, mounted on a poster board. Scientific committee will decide about the best poster. Posters will be displayed on specific boards during the conference.

1.

Title of Presentation

..... 2. Name of the presenting author 3. Academic Qualification 4. Institute/University. 5. Address for Communication 6. 7.

Contact no.(with STD Code): Home.. Office.. Mobile

Email (compulsory) Presentation shall be in power point

Declaration: I. Certify that this paper/Poster is the Original work done by me & this has not been presented/ submitted /accepted anywhere else for the presentation.

Place: Date: GUIDELINES:

Use English language only. Submit Abstract by e-mail: icmhaiims2014@gmail.com Limit your title to 100 letters and abstracts to 350 words. Authors: Type authors names without degree or title Prepare structured abstract with objectives, methods, results and conclusions. Define each abbreviation the first time it is used in the next by placing in parentheses. Do not include references in the abstract. Research paper accepted for oral or poster presentation will be included in the souvenirs. Submitted abstracts should have not been presented before. Registration for the conference is mandatory for scientific paper and poster presentation. Last date of Abstract submission: 30th Nov. 2013. Information about Acceptance of abstract shall be sent through email between: 15th December to 31st Dec 2013

Signature of Original Presenting Author

(Please Read the General Information for Submission)

STUDENT EVENT AND ENTRY FORM-ICMHAIIMS 2014

Scientific Quiz Competition

Entries are invited from the participating colleges, one team of 3 members each in categories for students of Medicine Physiotherapy, Nursing, Clinical Psychology, Diet & Nutrition, AYUSH Practitioners and Alternative Medicine and others. Screening of teams: The screening will be done by organizing committee by introduction of MCQ based Questionnaire during the conference.

There will be 45 MCQS to attempt in 15 minute time slab. For each correct answer 1 mark will be awarded There is no negative marking for incorrect answer Only top five selected team will reach the next round, which will be conducted on stage. The candidate should bring their own Pen/Markers etc

The highest 5 qualifying teams will participate for the final quiz competition to be held on the stage. Top Three teams will be awarded winning certificate and rest two will be awarded participation certificates during the valediction ceremony and certificate distribution program

Essay Writing Competition Theme and Topic of Essay Writing would be given on spot
Essay should have three parts which are introduction, body and conclusion, each separated with different paragraph. The detailed content should be precise and compacted. The reason is that it is reporting the fact, which is totally different from opinion based. It should not be less than 500 words in 20 minute time. Only Two candidates from each college will be allowed to participate. Best 3 essays will be awarded certificates during the closing ceremony and certificate distribution program The Theme /Topic of the essay will be announced prior to essay competition during the conference. Eligibility: Medicine Physiotherapy, Nursing, Clinical Psychology, Diet & Nutrition, AYUSH Practitioners and Alternative Medicine and others. Note: Language- English The candidate should bring their own Pen/Markers etc. Papers for essay competition will be provided to the participant by the organizing committee. Only 20-25 colleges will be allowed to participate on first come first basis & no college entry will be entertained after reaching the requisite number of entries of colleges Decision regarding Best essay awards is subject to selection by Organizing/Scientific Committee. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Poster Competition
Your poster must explain:
1) The scientific problem. 2) Its significance. 3) How your particular experiment addresses the problem/Implication. 4) The experiments performed / Materials and methodology. 5) The results 6) The conclusions Optionally, 7) Future prospects. Be brief, and always stay on point. Stress experimental strategy, key results, and your conclusions. Convey the Big Picture. Alternatively poster may convey a message of promoting physical therapy in the society or future prospects of physical therapy practice.

Specification of Poster
Flex printed poster of 36 inches by 48 inches

Inter College Cultural Program

Entries are invited from the participating colleges for the following categories in the cultural program section:

Rule:
One performance per college participants: minimum:8, maximum:10 10 minute time slab will be given to 10 selected colleges, and these colleges can use this 10 minute time slab to perform dance/drama/skit and their overall performance will be assessed by Organizing/cultural Committee. Note: The Interested colleges should send their entries as early as possible and will be entertained on first cum first basis. Kindly confirm whether you are performing as solo item or as a group item.

Marks:
Theme: 10 Costume: 10 Choreography: 10 Performance & Co-ordination: 10 New concepts/ innovative/uniqueness: 10 Overall Entertainers: 10

Note: kindly bring your own costumes, probes and other accessories required. Organizing committee will only provide Music system and Platform.

Scientific Innovation Award

Innovation award: Participant of this competition should bring their invented models and/or physiotherapeutic instrument/device with them which can be used either for clinical work/research work or diagnostic purposes. Best three innovation will be given award and certificates and rest will be given participation certificates.

Participate with full enthusiasm and zeal in all events. Surprising gifts/vouchers are waiting for you. (To be announced during the conference)

Rangoli Competition
60 minutes Participants: 1 to 3 Basic Colours would be provided. Additional Material to be used, if wished should brought by the participants One team per college.
THEME: Related to theme of the conference i.e., Bridging the Gap..Expanding the Horizon of Multidisciplinary healthcare. Design and color your Rangoli and write a small description of what it depicts or why is it special.

Marks: Theme: 10 Presentation: 10 Neatness: 10 Colour Combination: 10 Narration & Ambience: 10