21st Annual Fall Scientific Meeting of the SMSNA
Disclosure Declaration Form
The IUGA must insure balance, independence, objectivity, and scientific rigor in all its educational activities. The IUGA follows ACCCME regulations, meaning that we require all individuals in a position to control the content of an educational activity to fill out the disclosure form below prior to the initiation of the activity. In order to ensure our CME activities promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest, our CME provider will ask us to identify and resolve all conflicts of interest prior to the delivery of the activity to the learner. Based on this disclosure information, our CME Provider may disqualify any individual from planning and implementation if a conflict of interest that may contribute to commercial bias is determined to exist and cannot be resolved.
Individuals are required to disclose all relevant financial relationships with commercial interests (entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients) in any amount as well as the nature of the relationship within the past 12 months. In addition, an individual developing a presentation that provides information, in whole or in part, related to non-FDA approved uses for drug products or devices, must indicate his/her intention known to us by way of this form. The individual must also clearly identify the unlabeled indications or the investigational nature of the proposed uses to the learner.
In accordance with the Essential Elements and Standards of Commercial Support set forth by ACCME, the undersigned understands and accepts the policies and standards as set forth in this document.
All disclosure declarations will be communicated to the learner by means of a notation in the program or syllabus, or verbally by the activity director or moderator prior to the beginning of the activity. Individuals who do not provide the requested disclosure information will be disqualified from participating in the development and delivery of a CME activity.