ASCENSION PROVIDENCE HOSPITAL OFFICE OF CONTINUING MEDICAL EDUCATION DISCLOSURE

ASCENSION PROVIDENCE HOSPITAL OFFICE OF CONTINUING MEDICAL EDUCATION DISCLOSURE
ASCENSION ST JOHN HOSPITAL POLICY ON PROMOTIONAL MATERIALS AND
PARROCCHIA ASCENSIONE E LA PENTECOSTE CAMMINO DI RIPARTENZA 20172018

THE ASCENSION OF THE LORDYEAR B2021—ST LEONARD 1030 &

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

ASCENSION PROVIDENCE HOSPITAL

OFFICE OF CONTINUING MEDICAL EDUCATION

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

RELATED TO CONTINUING MEDICAL EDUCATION ACTIVITIES

A conflict of interest may be considered to exist if an individual, or spouse or partner of that individual, is in a position to affect CME content about the products or services of any commercial interests(s) in which he/she has had a financial relationship in the past twelve months. For this reason, all faculty members, speakers, authors, and planning committee members of CME activities must disclose any relevant relationships.

Any identified conflicts of interest for faculty members, speakers, authors, and planning committee members must be resolved before the CME activity is delivered to the learners. All relevant financial relationships must be disclosed to the learners at the beginning of the CME event.

Declaration Statement

I, or my spouse or partner, have had a relevant financial relationship in the past 12 months with a commercial interest(s) that may have a direct interest in the subject matter of the planned CME activity (C7 SCS 2.1).

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Providers of clinical service directly to patients are not considered commercial interests.

Name of Commercial Interest	Financial Relationship
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)
	Grant/Research Support Speakers Bureau Consultant Shareholder Other (Specify)

I declare that neither I, nor my spouse or partner, have had a relevant financial relationship in the past 12 months with any commercial interest(s) that may have a direct interest in the subject matter of the CME activity.

I acknowledge that I agree that all the recommendations involving clinical medicine are based on the best available evidence that is accepted within the medical profession as adequate justification for their indications and contraindications in the care of patients. Further, I agree that all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis. I will comply with the ACCME’s Policy on Content Validation*.

CME Activity:_____________________________________________________Date:_______________

Faculty Name:(please print)____________________________________________

Signature___________________________________________Date:_

If financial relationships are reported, the activity director is responsible for the completion of the Resolution of Conflict form on the following page.

*ACCME’s Policy on Content Validation: All the recommendations involving clinical medicine in a CME 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 CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis. Providers are not eligible for ACCME accreditation or reaccreditation if they present activities that promote recommendations, treatment or manners of practicing medicine that are not within the definition of CME, or known to have risks or dangers that outweigh the benefits or known to be ineffective in the treatment of patients.

ASCENSION PROVIDENCE HOSPITAL

RESOLUTION OF CONFLICT OF INTEREST FORM

Title of CME Activity: ____________________________________________________________________________

CME Activity Date(s): ___________________________________________________________________________

Speaker Name: ________________________________________________________________________________

The activity director, clinical planner, faculty member, scientific expert, or Department of CME staff member must complete this section if any faculty member, speaker, author, or planning committee member indicates a financial relationship with a product or service that will be discussed during the CME activity. Please indicate how the conflict of interest was resolved. (C7 SCS 2.3)

For a live CME activity: I have reviewed the evidenced-based slides, disclosure slide, handouts, and/or references for this presentation prior to the CME activity and can verify that they are free of commercial bias and contain fair and balanced content.
For a live CME case review series: I affirm that this faculty member is aware that any recommended treatment options involving clinical medicine are based on the best available evidence that is accepted within the medical profession as adequate justification for their indications and contraindications in the care of patients. Also, it has been verified that the selection of cases is based on educational purposes only, and cases are chosen by a team of educators/experts to ensure compliance. Therefore, I can verify that this series has been planned to be free of commercial bias and contains fair and balanced content. Every session will be monitored to ensure adherence to this policy.(C7 SCS 6.4)
For an enduring material CME activity: I reviewed the material of this CME activity and can verify that it is free of commercial bias and contains fair and balanced content.
Other type of CME Format _______________________________________________________________________
Other process to resolve this COI is described below:

______________________________________________________________________________________________________________________________________

I verify that the conflict of interest indicated by this faculty member, speaker, author, or planning committee member has been resolved as indicated above.

______________________________________ _______________________

Reviewer Signature Date

To be completed by CME Department:

COI could not be resolved prior to the CME activity. Hence, this faculty member, speaker, author, or planning committee member has been replaced and will not participate in this CME activity OR CME activity occurred without category 1 credit. (C7 SCS 2.2)

__________________________________________ _________________________

CME Coordinator Date

__________________________________________ _________________________

Director of Medical Education Date

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ASCENSION PROVIDENCE HOSPITAL OFFICE OF CONTINUING MEDICAL EDUCATION DISCLOSURE

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

Declaration Statement

Signature_________________________________________________________Date:_______________

Signature___________________________________________Date:_