DISCLOSURE OF FINANCIAL INTERESTS FORM - Poster Display 2025-2026

In compliance with ACCME’s Standards for Commercial Support, the APA, as the CME provider of this activity, has a disclosure process to ensure that everyone who is in a position to control the content of the educational activity has disclosed all financial relationships with any commercial interest within the past twelve months (see glossary definitions). The APA has mechanisms in place to identify and resolve all conflicts of interest prior to an educational activity.
The prospective audience must be informed of the planners’ and presenters’ affiliations with relevant commercial organizations by an acknowledgement in the printed program and oral or visual disclosure to participants at the session. Disclosure by slide or overhead is required if audiovisual equipment is used for the presentation. If an individual has no relationships, the learner must be informed of that as well. The APA also requires presenters to orally disclose unapproved or investigational uses of a product not yet approved for this purpose.
Each planner and participant (including co-chairpersons, discussants, and all authors) must return a completed Disclosure Form, even if no relationship exists. An individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a faculty member, or an author of CME. (Photocopies of the Disclosure Form may be used)

DISCLOSURE OF FINANCIAL OR OTHER RELEVANT RELATIONSHIPS

Please complete each of the following questions:
Do you or your spouse/partner have any financial relationships with commercial interest?
Yes or No
If yes, please provide complete information:
Full Disclosure Index
List the name(s) and nature of relationship(s) with commercial interest(s) within the past 12 month.
Stock/Other Financial Options
Consultant
Grant/Research Support
Employee
Speaker’s Bureau
Other Financial Interests

DISCLOSURE OF DISCUSSION OF “OFF-LABEL” OR INVESTIGATIONAL USES OF DRUGS AND DEVICES

Will you discuss unapproved uses of a commercial product, or investigational use of a product not yet approved for this purpose, during your presentation(s) at this educational activity.
I will or I will not
If I have indicated a financial relationship and/or if I will discuss unapproved or investigational use of a product, I understand that I am responsible for disclosing this information to the audience during my presentation.

BY SIGNING THIS FORM I COMMIT TO PRESENTING A FAIR AND BALANCED CME PROGRAM.

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ACCME Glossary of Terms
Commercial Interest
The ACCME defines a commercial interest as 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 preceding 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.
Conflict of Interest
Circumstances create a conflict of interest when an individual has an opportunity to affect CME content regarding products or services of a commercial interest with which he/she has a financial relationship.
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