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Would you like to meet with a federal agency regarding a Medical Diagnostic Product that you are developing? If you
submit some basic information on that product, we will evaluate your request and route it to the most appropriate
resource within the federal government. In some instances, it is not necessary or appropriate for a federal agency
representative to meet with companies regarding their products. In the event that a federal agency representative is
unable to meet with you, we will provide you with that information in a timely manner.
All submissions to MedicalCountermeasures.gov are voluntary and are for information only. However, the submission
of complete information may facilitate the routing of your request. It is important that we route your request to the most
appropriate federal entity. By selecting all federal entities listed below, you increase the probability that we will be able
to route your request appropriately. However, selecting all of the federal entities above does not guarantee that it is
appropriate for the federal government to meet with you at this time.
A field with an asterisk (*) before it is a required field
Requestor Phone

-

-

Company URL
Product Name
*Category of Threat Agent Radiological/Nuclear
Specific Threat Agent (choose Check All
all that apply)
c Acute Radiation Syndrome
d
e
f
g
c Chronic Effects of Radiation
d
e
f
g
Exposure

Uncheck All
c Internal Contamination
d
e
f
g
g Other (Please Specify)
c
d
e
f

c Burn/Blast Injury
d
e
f
g

Technology Readiness Level

Technology Readiness Level Descriptions

Source of Sample for Testing Check All

http://hhsdev.dyonyx.com/Restricted/Diagnostic.aspx

Uncheck All

c Blood
d
e
f
g

c Sputum
d
e
f
g

g Urine
c
d
e
f

g Other (please specify)
c
d
e
f

9/26/2007

MedicalCounterMeasures.gov

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c Stool
d
e
f
g

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proprietary, confidential, or
trade secret information?
Please select those federal
entities that you would be
interested in potentially meeting
with. Please do not select an
entity in which you are currently
competing for a contract under
as active solicitation issued in
accordance with the Federal
Acquisition Regulation.
Comments

n No m
j
k
l
m
n Yes
j
k
l

Uncheck All

Check All
b HHS/BARDA
c
d
e
f
g

b HHS/FDA
c
d
e
f
g

g HHS/CDC
b
c
d
e
f

g HHS/NIH
b
c
d
e
f

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9/26/2007