FINANCIAL RELATIONSHIPS DISCLOSURE FORM

Please complete the mandatory online form below required for all Authors, Co-Authors, Speakers, Presenters, Moderators, Content Reviewers, Activity Planners (non-presenter), and CME Coordinators.

It is the Authors responsibility to ensure that Co-Authors comply. Abstracts will not be considered unless all Co-Authors have completed the Financial Relationships Disclosure Form within
10 days of Abstract or Poster submission in order for the Abstract or Poster to be considered by the Committee.

The Financial Relationships Disclosure Form must be submitted prior to participation.

For Authors, Co-Authors, Speakers, Presenters, Moderators, Content Reviewers,
Activity Planners (Non-Presenter), and CME Coordinators

Criteria for Disclosure of Financial Relationships
with Commercial Interests in Continuing Medical Education

  1. Presenters, Activity Planners, Content Reviewers, Authors, Co-Authors and Coordinators who affect 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 this CME activity.
  2. You are to disclose financial relationships in any amount that have been received over the past 12 months ONLY.
  3. Financial relationships with governmental agencies (e.g., the NIH) and organizations that do not fit the above definition do not have to be disclosed.
  4. Honoraria received, or consulting funds, from a CME provider, even though those funds may have been provided to that CME provider through an educational grant from a commercial interest, do not have to be disclosed.
  5. If you are a principal investigator for a drug study, you must report that research relationship below under "contracted research” even if those funds came to an institution.
  6. If your spouse or life partner has a relevant financial relationship with an applicable manufacturer (e.g., is employed as the VP-Marketing), or provides marketing advice to applicable manufacturers as a consultant, you must include that disclosure below.
  7. 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 speaker, activity planner, content reviewer or coordinator from this activity.