As part of the NSGC's mission, the Practice Guidelines Committee (PGC) is charged with developing trustworthy clinical practice guidelines to help promote the provision of high quality, evidence-based care. The PGC is committed to minimizing any real or perceived conflict of interest (COI) for anyone involved in the guideline development process. Presence of a COI does not automatically preclude participation in a NSGC Practice Guideline activity and we recognize that many experts may have a COI to disclose. In many cases, full disclosure of the actual potentially conflicting relationship will by itself suffice.

The goal of this survey is to broadly collect information pertaining to potential COI to help our Committee assure we are being as transparent and honest as possible; however, disclosures will be evaluated as relevant to your specific role(s) and often will not preclude your involvement. The items on this survey are modeled after those used by other organizations developing clinical practice guidelines.

To the best of your knowledge, please answer each of the following questions and disclose any relationships that you currently have (or have had) during the preceding 12-month period (unless otherwise noted). We greatly appreciate complete answers to these questions, even if you do not feel they directly relate to the specific work of the PGC for which you are being considered. Given the thoroughness of this form, many individuals will have a potential COI to disclose.

All survey answers you provide will be kept strictly confidential by those reviewing them on the PGC. However, if you feel uncomfortable completing some questions, you may request a phone meeting with the Practice Guidelines Committee Chairs to discuss your concerns.

It can be challenging to think of (and remember) what may constitute a real or perceived COI. This survey will prompt you to think about your relationship(s) with commercial interests or government/not-for-profit organizations, including dates and topic areas of activities, and details about compensation. The following are some examples:

1. Employment relationships
2. Consulting relationships
3. Grants
4. Royalties
5. Stocks/stock options
6. Speaking engagements
7. Board and Committee memberships
8. Legal testimony
9. Research projects
10. Intellectual property, including patents

Question Title

* 1. Please state the reason for completing the PGC COI Disclosure Form.