1 Start 2 Complete Introduction The CME Learning Portal for UofSC SOMG/Prisma Health-Upstate requires that conference content, faculty presentations, discussions and educational materials comply with the appropriate standards and must ensure balance, independence, objectivity, and scientific rigor in all its individually sponsored education activities. This document must be completed by all individuals who have influence over the content of the educational activity. Persons who fail to complete the form are not eligible to be involved as a presenter/planner. Definitions Commercial InterestThe ACCME defines a "commercial interest" as any entity producing, marketing, reselling, or distributing healthcare goods or services, used on, or consumed by, patients. The ACCME does not consider providers of clinical service directly to patients to be commercials interests. For more information, visit www.accme.org. Financial RelationshipsFinancial 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. ACCME considers relationships of the person involved in the CME activity to include financial relationships or a spouse or partner. Relevant Financial RelationshipsACCME 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 controlled 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 InterestCircumstances 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 he/she has a financial relationship. Disclosure Attestation Attestation * Do you or your partner have any relevant financial relationships to disclose within the past 12 months? Disclosure should include relationships in any amount. No, I have not had a relevant financial relationship within the past 12 months. Yes, I have had a relevant financial relationship within the past 12 months. Name * Full, legal name Date * Today's Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Financial Relationships * Attribution - Select - Self Spouse/Partner Dependent Child Other Type of Relationship * Type of Financial Relationship - Select - Employment Independent Contractor Fiduciary Officer Other Travel Grant/Contract Gift Other Copyright Intellectual Property Other Other Business Ownership Other Securities Patent Stock Options Stock Trademark- Select - Commercial Interest * Name of Entity Topic * Leave this field blank