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ICNP Modify Concept Submission Form

  • Submitted by
  • Name of Submitter
  • Title/Position
  • Postal Address
  • Street
  • City
  • Province or State
  • Postal Code
  • Country
  • Telephone
  • Fax Number
  • E-mail
  • Current Concept
  • Current Concept Description
  • Current Synonym(s) or related concept(s)
  • Modified Concept
  • Modified Concept Description
  • Use Case for Modified Concept
  • Synonym(s) or related concept(s) for Modified Concept
  • Scientific evidence (eg, literature review) supporting concept modification:
  • Citation 1
  • Citation 2
  • Continue as Needed
  • Additional comments or information for reviewers and ICN:

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