Disclosure Form Joint Providership

CME Outfitters, LLC – Faculty Financial Relationships

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  • CME Outfitters (CMEO) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. CMEO is committed to ensuring that all jointly provided activities are planned and implemented in accordance with the Joint Accreditation for Interprofessional Continuing Education™ Accreditation Requirements, Guidelines, Policies and Accreditation Council for Continuing Medical Education (ACCME) Standards for Integrity and Independence.

    First, list the names of ineligible entities (defined in the “Glossary of Terms” below) with which you have, or have had, a financial relationship within the past 24 months. Second, describe what you received (ex: salary, fee, research grant, etc.). CME Outfitters does NOT want to know how much you received. Third, describe your role.

    Evidence for financial interest or other relationship may include: receiving grants/research support, current or recent history of employment with, consultantship to or ownership interests in a company, or being a member of a speakers bureau. Disclosing a relationship or affiliation with any commercial organization does not necessarily prevent someone from making a presentation. However, if it is determined that the financial relationship may cause conflict of interest, the faculty member has the option to alter the relationship so that a conflict no longer exists, or CME Outfitters will manage and mitigate the conflict in order to ensure activities are free of commercial bias. The policy is designed to place a higher priority on the health and well-being of the public than on individuals’ personal economic interests.

  • If Yes, please provide details in the space provided.
  • I understand that this form will be available for review by accrediting bodies, as well as participants.
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Example terminology
What was received: Salary, royalty, intellectual property rights, research grant, consulting fee, speaker fee, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Role(s): Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and ‘other activities (please specify).

Glossary of Terms

Commercial Interest

The ACCME defines a “commercial interest” as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. For more information, visit www.accme.org.

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.

The ACCME focuses on financial relationships with commercial interests in the 24-month period preceding the time that the individual is being asked to assume a role controlling content of the CE 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 “financial relationships” as financial relationships in any amount occurring within the past 24 months that create a conflict of interest.

Conflict of Interest

Circumstances create a conflict of interest when an individual has an opportunity to affect CE content about products or services of a commercial interest with which he/she has a financial relationship.