1. Handling disclosures of financial relationships with commercial interests in grand rounds sessions

2. Slide 3: No relevant financial relationships to disclose by either the speaker or course planner Slide 4: Financial relationships with commercial interests to disclose – presenter Slide 5: financial relationships with commercial interests to disclose – course planner(s)/moderator(s)/panelists/chairperson(s) Slide 6: Disclosure statement of unapproved/investigative use Slide 7: Disclosure statement of discussion of off-label medication(s)

3. Disclosures
I have no actual or potential conflict of interest in relation to this program/presentation.
The following planners, speakers, moderators, and/or panelists of this CE activity have no relevant financial relationships with commercial interests to disclose:
[Add names of relevant persons here]

4. Disclosures I disclose the following relevant financial relationships:
Grant/Research Support: [List all companies or omit for no disclosure]
Consultant: [List all companies or omit for no disclosure]
Stock/Shareholder: [List all companies or omit for no disclosure]
Other: [List all companies or omit for no disclosure]

5. Disclosures
The following planner, speaker, moderator, panelist (select what is appropriate, erase the rest) has financial relationships with commercial interests to disclose:
[list the name of the planner, etc. here]
[List the commercial interest indicated on the disclosure form here] [list the nature of the relationship here]
Department chair/Division Director, [insert name]
Has no financial relationships to disclose
Has financial relationships with the following commercial interests to disclose:

6. Disclosure Statement of Unapproved/Investigative Use
In this CME activity I will [not] discuss unapproved or investigational uses of products or devices.
There is no commercial support for this Grand Rounds. OR
This Grand Rounds is supported by an educational grant from (name of corporate supporter)

7. Disclosure
I will be discussing “off-label” uses of the following medications:
List Medications