CRITERIA FOR DISCLOSURE OF FINANCIAL RELATIONSHIPS IN CONTINUING MEDICAL EDUCATION
 
ACCME guidelines require that all Activity Planners, Presenters, Content Reviewers, Authors and Coordinators who affect or are in control of the content of a CME activity are required to disclose all financial relationships they have with commercial interests (i.e., any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients) associated with a CME activity.
 
Conflict of Interest: When individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. When a person divests themselves of a financial relationship it is immediately not a conflict of interest but the relationship must be disclosed to the learners for 12 months. 
  • You are to disclose financial relationships in any amount that have been received over the past 12 months only.
  • Financial relationships with governmental agencies (e.g., the NIH) and organizations that do not fit the above definition do not have to be disclosed.
  • If you are a principal investigator for a drug study, you must report that research relationship below under Grant / Research Support, even if those funds came to an institution.
  • If your spouse or life partner has a relevant financial relationship with a commercial interest (see above for complete definition of a commercial interest) you must include that disclosure in the table below.
  • All recommendations involving clinical medicine in this activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in a CME activity in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.
  • In accordance with ACCME, ANCC and ACPE requirements, failure to provide disclosure information in a timely manner will result in the disqualification of the potential program chair, presenter/moderator, content reviewer, activity coordinator, or author from this activity.
  • Trade names and pharmaceutical logos/advertisements are prohibited. The ACCME insists on the separation of education from all promotional activities, materials and messages. Educational materials that are a part of this activity, such as slides, abstracts, and handouts, will not contain any advertising, trade names, or product-group messages. The ACCME does not permit logos of commercial interest organizations in education materials such as slides.
  • The financial relationships disclosed will be provided to activity participants in written form via publication in the activity Proceedings. Speakers / presenters are further required to verbally and visually disclose the financial information and off-label uses and limitations of data related to patient care via a slide shown to the audience prior to the presentation. For this purpose, please access the Disclosure Slide Template.
  • Your responses to the questions below might require a review of your presentation prior to the start of the activity.

Question Title

* 1. Contact Information:

Question Title

* 2. Indicate all of your roles for this CME activity:
(check all that apply)

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* 3. Attestation: In my role for this CME Activity, I attest that: (a) My contributions will be free from commercial bias or influence. (b) Any clinical practice recommendations relating to my contributions to this activity will be supported by the best available evidence, or absent evidence, will be consistent with generally accepted medical practice and scientific method. (c) I will present a balanced view of reasonable clinical alternatives. (d) I am qualified by my education and/or experience to develop content and teach in this topic area.
I SO ATTEST:

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