Joint Provider Attestation Form

CME Outfitters (CMEO) is committed to ensuring that all jointly provided activities are planned and implemented in accordance with the Accreditation Council for Continuing Medical Education (ACCME) Accreditation Requirements, Policies and Standards for Integrity and Independence. CMEO does not jointly provide activities with ineligible entities/commercial interests, which are defined by the ACCME as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

To facilitate the determination of your eligibility to enter into a joint providership relationship with CMEO, we ask that you complete the following questionnaire and return it for our review.

  • Organization

  • If yes, please identify your parent organization.
  • Attestation

    I hereby certify that the above information is correct and that the CME Outfitters will be immediately notified if any of the above information changes.
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