PRESENTERS/FACULTY - CME Disclosure & Attestation

We are pleased that you are willing to participate in Children's of Alabama sponsored Continuing Medical Education (CME). We seek to provide needs-based educational opportunities to improve healthcare quality.

Children's of Alabama is accredited by the Medical Association of the State of Alabama to offer continuing medical education to physicians. As such, we have made the choice to meet the Accreditation Council for Continuing Medical Education's (ACCME) expectations for our practice of continuing medical education. We look forward to working together to provide CME at the highest standard.

CME Activity Content Standards

Children's of Alabama requires that the content of CME activities and related materials provide balance, independence, objectivity and scientific rigor. Content must be free of the influence or control of a commercial entity and must promote improvements or quality in healthcare.

Regarding CME content, it is the policy and expectation of Children's of Alabama that:

All recommendations involving clinical medicine be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.

All scientific research referred to, reported or used in this activity in support of justification of a patient care recommendation conform to the generally accepted standards of experimental design, data collection and analysis.

When discussing therapeutic options, it is our preference that you use only generic names. If it is necessary to use a trade name, then those of several companies must be used.

Disclosure & Attestation

Children's of Alabama has implemented a process for obtaining disclosure of all relevant financial relationships with any commercial interest by those in a position to control an education activity's planning, approval or content. Also Children's of Alabama seeks to preserve the CME participation of all presenters through their attestation to certain statements regarding their role.

Conflicts of interest develop when an individual has an opportunity to affect CME content about the products or services of a commercial interest with which he/she has a financial 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. (See Glossary at end for additional definitions of terms).

Through your completion of the attached form, we can inform CME participants about your relevant financial or other relationships and also can move to the next steps in your CME activity participation. Refusal to provide disclosure and attest compliance with our CME role statements (page 3) disqualifies one from participating in Children's of Alabama CME activity planning and implementation.

Please do NOT use apostrophe in Company Name.
CME Role(s) *
Please choose all that apply.
Please fill out titles on separate rows below:
Part 1: Disclosure
Answer YES or NO below, if YES, specify:
Answer YES or NO below, if YES, specify:
Answer YES or NO below if known, if YES, specify:
I am personally receiving an honorarium for this activity. *
Please check the correct statement below: *
Organizations with Commercial Interest
If none, please proceed to first electronic signature:
Part 2: Attestation
Please indicate your understanding of and willingness to comply with each statement below. If you have any questions regarding your ability to comply, please contact the activity coordinator as soon as possible.
I agree to the below statements: *
I have carefully read and considered each item above and have responded to the best of my ability. *

Glossary of Terms

Commercial Interest

The ACCME defines a "commercial interest" as any proprietary entity producing healthcare goods or services, with the exemption of non-profit or government organizations and non-health care related companies.

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 for which remuneration is received or expected. ACCME considers relationships of the person involved in the CME activity to include 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 about products or services of a commercial interest with which she/he has a financial relationship.