Online Medical Education

Furthering Education in the Medical Field

In association with CMEsolutions.org


CMEsolutions, LLC and Online Medical Education are dedicated to education for physicians, pharmacists, and others involved in the health care field. Our mission is to provide high-quality continuing medical education opportunities that promote lifelong learning for practicing physicians, pharmacists and other health care professionals.

These are samples of some of the services we offer. These are samples only and do not actually submit the information anywhere. 


Faculty/Planner Disclosure Form

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Pharmacy Education (ACPE), CMEsolutions must insure balance, independence, objectivity, and scientific rigor in all its individually provided or jointly provided educational activities. All faculty, planners and directors involved in an accredited activity are expected to disclose any relevant financial relationships with any commercial interest in any amount occurring within the past 12 months.

Name:

Title of Your Presentation:

Date of Activity:

Activity Title:

Your role in this CME activity:
Presentor Author Moderator Panel Planner Advisory

Disclosure

The intent of this disclosure is not to prevent a speaker with a significant financial or other relationship from making a presentation, but rather to provide listeners with information from which they can make their own judgments. It remains for the audience to determine whether the speaker’s interests or relationships may influence the presentation with regard to exposition or conclusion. Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

Have you (or your spouse/partner) had any relevant financial relationships in the last 12 months with the manufacturer of the products or services of a commercial interest? "A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.”

NO - Skip to Declaration YES - Please list your disclosures below and complete resolution section


Commercial Interest


Nature of Relevant Financial Relationship
(Include all those that apply)
 With Whom: What was Received
Salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.
For What Role?
Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on review panels, board membership, and ‘other activities (please specify).


By checking this box, I am providing my electronic signature affirming that all the information entered above is accurate and complete. I have identified and resolved in writing all potential conflicts of interests. As a planning committee member or presenter, I am resolving my conflict of interest by agreeing that I will not allow any conflict of interest or commercial support to bias my participation in this activity.

Glossary of Terms

Commercial Interest
The ACCME defines A ‘commercial interest’ is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial relationships
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

Relevant financial relationships
ACCME focuses on financial relationships with commercial interests in the 12-month period before the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.