Please list your administrative assistant's name and contact information (if applicable)
The potential for conflicts of interest exists when an individual has the ability to control or influence the content of an educational activity and has a financial relationship with a commercial interest,* the products or services of which are pertinent to the content of the educational activity.
*Commercial interest, as defined by ACCME, ANCC and ACPE, is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients (excepting non-profits, government organizations or providers of clinical services directly to patients).
All individuals who have the ability to control or influence the content of an educational activity must disclose all relevant relationships** with any commercial interest, including but not limited to members of the Planning Committee, speakers, presenters, authors, and/or content reviewers. Relevant relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. All information disclosed must be shared with the participants/learners prior to the start of the educational activity.
**Relevant relationships, as defined by ANCC, ACPE, AARC and ACCME are relationships with a commercial interest if the products or services of the commercial interest are related to the content of the educational activity.
By typing your name or uploading your electronic signature below, you are attesting that all clinical recommendations are based on evidence that is accepted within the profession of medicine and all scientific research referred to, reported, or used in support of or justification of patient care recommendations conforms to the generally accepted standards of experimental design, data collection and analysis.
You are also attesting to the accuracy of the information submitted in this Biographical & Conflict of Interest Form.