FINANCIAL RELATIONSHIPS DISCLOSURE FORM

For Program Chair, Authors, Co-Authors, Presenters, Moderators, Content Reviewers,
Activity Coordinators (non-presenter), and Coordinators of Continuing Medical Education activities
. 

Please complete the mandatory online form below required for all Authors, Co-Authors, Program Chair, Speakers, Presenters, Moderators, Content Reviewers, Activity Coordinators (non-presenter), and Coordinators of Continuing Medical Education activities.

It is the Primary Authors responsibility to ensure that Co-Authors complete the Financial Relationships Disclosure Form on or before December 10, 2018. 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 Abstract Selection Committee.

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 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.
  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 a commercial interest (see #1 for complete definition of commercial interest), 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 program chair, presenter/moderator, content reviewer, activity coordinator, or author from this activity.