1 Faculty Disclosure Information Elements Name of FacultyTitle of PresentationName of Commercial InterestInformation about nature of relationship, financial disclosure means the role they play or service they provide in exchange for some form of compensation (e.g., employment, management position, independent contractor including contracted research, consulting, speaking and teaching, membership on advisory committees or review panels and board membership).Repeat 2 and 3 for each commercial interestUnlabeled/Unapproved Uses Disclosure: (Does faculty intend to discuss drug usage that are off label? If so, include that information here.)If faculty has no relevant financial relationships – that must be disclosed as well. “No relevant financial relationship(s) exist.”Faculty Disclosure information must be included at the top of the activity. Learners must be given enough time to read the information. If time permits, it’s best to have the faculty verbally disclose the information as well. If the faculty member has nothing to disclose – that too must be disclosed – see point 6 above on the slide. This information helps provide the learner with the opportunity to make a determination if they feel the content of the activity will be presented fairly, in an unbiased manner.The above information included on the slide supports the following standards from The Standards For Commercial Support:STANDARD 6.Disclosures Relevant toPotential Commercial BiasRelevant financial relationships of those with control overCME content6.1 An individual must disclose to learners anyrelevant financial relationship(s), to include thefollowing information:• The name of the individual;• The name of the commercial interest(s);• The nature of the relationship the personhas with each commercial interest.6.2 For an individual with no relevant financialrelationship(s) the learners must be informedthat no relevant financial relationship(s) exist.
2 Presenter Disclosure Information [Insert presenter name] [insert title of presentation] FINANCIAL DISCLOSURE: [Insert description of relationship with commercial supporter and name of commercial supporter.] UNLABELED/UNAPPROVED USES DISCLOSURE: [Describe intended unlabeled/unapproved use in presentation.]
3 Presenter Disclosure Information John Q. Smith, MD Dilation of Coronary Stenosis FINANCIAL DISCLOSURE: Grants/Research Support: ABC Pharmaceuticals Speakers Bureau: XYZ Manufacturing UNLABELED/UNAPPROVED USES DISCLOSURE: Use of L-Arginine in patients with acute coronary syndrome is investigational onlySAMPLE SLIDE
4 Presenter Disclosure Information John Q. Smith, MD Dilation of Coronary Stenosis FINANCIAL DISCLOSURE: No relevant financial relationship existsSAMPLE SLIDE