Faculty Disclosures

Relevant Financial Relationships for Continuing Medical Education

For faculty, committee members

The Accreditation Council for Continuing Medical Education (ACCME) has implemented a process where anyone in a position to control or influence the content of an AMA Category 1 Credit CME activity must disclosed all relevant financial relationships with any commercial interest (see below for definitions). In addition, should it be determined that a conflict of interest exists as a result of a financial relationship you, your spouse, a family member or significant other partner may have, this will need to be resolved prior to the activity. 

Please provide us with the following information which is necessary in order for us to be able to move to the next steps in planning this CME activity.

If you do not to complete and return this form, you may not participate in the planning and implementation of this CME activity.

Please download the Faculty Disclosure form and return by February 5, 2018.

Return to the CND Office by faxing to +1 386 437-4427 or email to [email protected] or to [email protected]


1. RELATIVE TO THIS ACTIVITY, instructors, planners, content reviewers and managers who affect the content of a CME activity are required to disclose financial relationships they have with commercial interests (i.e., any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients).

2. Disclose financial relationships with a commercial interest relevant to the activity.

3. You are to disclose financial relationships that fit #2 above in any amount that has been received over the past 12 months ONLY.

4. Financial relationships with governmental agencies (e.g., the NIH) and organizations that do not fit the above definition do not have to be disclosed.

5. Honoraria received, or consulting funds, from a CME provider, even though those funds may have been provided to that CME/CE provider through an educational grant from a commercial interest, do not have to be disclosed.

6. If you are a principal investigator for a drug study, you must report that research relationship below under "Contracted Research" even if those funds came to an institution.

7. If your spouse or life partner has a relevant financial relationship with an applicable commercial interest (e.g., is employed as the VP-Marketing), or provides marketing advice to an applicable commercial interest as a consultant, you must include that disclosure in the table below.

8. In accordance with ACCME requirements, failure to provide disclosure information in a timely manner will result in the disqualification of the potential planner, course director, moderator, faculty, presenter, author or reviewer from this activity.

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