COI Disclosure form ~ 155th Annual AOS Spring meeting 
April 29 - May 1, 2022

In order to complete Part I of the AOS Abstract submission process, as the Primary author, please complete the following Conflict of Interest/Disclosure form as it relates to you as the primary author. If you are not the presenter, you will be required to complete a COI/DISCLOSURE for the presenter as well. 

You Must Indicate ONE of the Following when Submitting Your Abstract.
  • ORAL (will be considered for ORAL presentation only)
  • POSTER (option of adding a short audio file if selected)
  • EITHER (Selecting this category does not lessen your chances of being selected for an ORAL presentation)
The preferred method of presentation (ORAL or POSTER) should be noted. If you select EITHER, the AOS Program Advisory Committee will make the final determination as to where to place your abstract. The same submission rules apply for both POSTER and ORAL submissions. In order to be considered for an award, the abstract must first be selected by the Program Advisory Committee as an ORAL presentation, (you may submit as ORAL or EITHER).

FROM THE SUBMISSION FORM RE IRB:
Approval of your studies/research must be acquired before the data is collected. Any data collected prior to IRB approval is in violation of IRB rules. IRB APPROVAL MUST BE DISCLOSED AT THE TIME OF SUBMISSION. You must enter the IRB/IACUC number and/or the name of the entity providing approval on the template provided for your abstract submission. Simply entering YES is in not acceptable. NO EXCEPTIONS. If the study has qualified as exempt from an IRB formal review, authors may state EXEMPT on the abstract submission form.

OUT of USA SUBMISSIONS:
APPROVAL MUST BE OBTAINED & NOTED from the appropriate ethical entity at the time of submission.
*Failure to comply will result in disqualification of your abstract
 
Upon successful completion of the COI/Disclosure form, you will be automatically directed to the AOS website and the Abstract submission form. Your abstract submission will be sent electronically to the AOS Administrative Office.

THANK YOU FOR YOUR COMPLIANCE!
Kristen Bordignon & Ashley Eikenberry
AOS Administrative Team

FROM THE AMERICAN COLLEGE OF SURGEONS, THE ACCREDITED PROVIDER:

In accordance with ACCME regulations, the American College of Surgeons must ensure that anyone who is in a position to control the content of the education activity has disclosed all financial relationships with any commercial interests (termed by the ACCME as “ineligible companies”, defined below) in the last 24 months prior to their involvement of the educational activity.

Ineligible Company: Defined by the ACCME as any entity producing, marketing, re-selling, or distributing health care goods or services used on or consumed by patients. Providers of clinical services directly to patients are NOT included in this definition.

Financial Relationships: Relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benFailure or refusal to disclose or the inability to manage the identified conflict will result in the withdrawal of the invitation to participate.

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

All CME Planners and Speakers /Moderators/Discussants/Authors/Editors involved in the development and/or presentation of CME content must complete this form. If applicable, the first author is responsible for collecting and submitting disclosure information on behalf of all other authors/contributors. The form must be updated whenever circumstances require. In addition, all affirmative disclosures for speakers must be revealed by a slide at the beginning of the presentation.

Failure or refusal to disclose or the inability to manage the identified conflict will result in the withdrawal of the invitation to participate.

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* 1. Please complete the following contact information:

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* 2. Title of Abstract: (must match EXACTLY with your Abstract submission title) TRADE NAMES ARE NOT PERMITTED WITHIN THE TITLE when a GENERIC TERM is available.

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* 3. What is your role in this CME Activity: (Check all that apply)

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* 4. I disclose the following:

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* 5. I have disclosed to the AOS all relevant financial relationships, and I will disclose this information to learners verbally (for live activities) and in print.

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* 6. I agree that I will not accept honoraria, travel expenses, in-kind contributions, or any other support from commercial companies in connection with this activity.

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* 7. If any of the information reported above changes, I will notify AOS immediately and update this form accordingly.

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* 8. By checking this box I confirm this abstract is exclusive to AOS and I will NOT submit it to any other participating COSM society, this includes ANS. I understand that a duplicate submission to ANS & AOS will disqualify my abstract from both Societies.

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* 9. By signing or typing my name below, as the PRIMARY AUTHOR, I certify that I have identified and disclosed all financial relationships with any commercial interests and that all information provided herein is true and correct.

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* 10. I am the primary author and presenter.

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