Disclosure Information

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You must read the information provided and answer the questions regarding your financial relationships with ineligible companies to participate in this activity.

As a prospective planner or faculty member, we would like to ask for your help in protecting our learning environment from industry influence. Please complete the form below and submit.

The ACCME Standards for Integrity and Independence require that we disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited continuing education. Thank you for your diligence and assistance. If you have questions, please contact us at [email protected].

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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
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Choose all that apply
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If you have more than one ineligible company, please answer "yes" to this question.
If more than 6 financial relationships, submit this form and contact your CME coordinator/administrator

Faculty/Speaker/Authors for CME activities - additional agreements:

  1. Will not actively promote or sell products or services during accredited education. 
  2. Will not include product logos or trade names of an ineligible company; or, if it is necessary to include trade names in a presentation will endeavor to mention the trade names of several companies, not just trade names from a single company. 
  3. Will not receive direct remuneration from an ineligible company. 
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Excerpted from the Toolkit for the Standards for Integrity and Independence in Accredited Continuing Education
© 2020 by the Accreditation Council for Continuing Medical Education (ACCME®)