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* First Name

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* Middle Initial

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* Last Name

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* Credential(s) (i.e., MD, DO, etc.)

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* Name of the Education Activity: 

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* Presentation Title (i.e., Please provide the title of your presentation only if you are giving a talk )

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* Please Select your Role(s):

INSTRUCTIONS

Related to CME, all individuals who are involved in the development and presentation of content are required to disclose (or report) all financial relationships they hold with an ACCME-defined "ineligible company" *, within the last 24 months.

An "ineligible company" is defined by ACCME as "companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients." Examples of such organizations include:
  • Advertising, marketing, or communication firms whose clients are ineligible companies
  • Bio-medical startups that have begun a governmental regulatory approval process
  • Compounding pharmacies that manufacture proprietary compounds
  • Device manufacturers or distributors
  • Diagnostic labs that sell proprietary products
  • Growers, distributors, manufacturers, or sellers of medical foods and dietary supplements
  • Manufacturers of health-related wearable products
  • Pharmaceutical companies or distributors
  • Pharmacy benefit managers
  • Reagent manufacturers or sellers
What you MUST disclose:
  • ALL financial relationships with ACCME defined ineligible companies within in the last 24 months (of the current date)
  • There is no minimum financial threshold
  • Individual stocks and stock options
  • A principal investigator role for a drug study must report that relationship as “Contracted Research”, even your institution receives the research grant and manages the funds.

You are not required to disclose:
  • Financial relationships with governmental agencies (e.g., the NIH)
  • Honoraria or consulting funds, from an approved CME/CE provider.
  • Employment with schools of medicine or health science universities.
  • Diversified mutual funds

Owners and employees of ACCME-defined ineligible companies are not permitted to participate as planners or faculty of CME activities, as their financial relationships are considered unresolvable.

Eligibility | ACCME

[ACCME Standard 3.2]- Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships | ACCME

Owners: are defined as individuals who have an ownership interest in a company, except for stockholders of publicly traded companies or holders of shares through a pension or mutual fund.

Employees: are defined as individuals hired to work for another person or business (the employer) for compensation and who are subject to the employer's direction as to the details of how to perform the job.

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