Below is information on how to list disclosure information on the flyer for your RSC
activities.
#1 The word relevant must be within the disclosure statements.
DISCLOSURE STATEMENT: Dr. _____________ (Choose one/two of the statements
below to complete the sentence. Delete all other information)
·
has disclosed no relevant financial relationships
·
has disclosed a relevant financial relationship: list company name and type of
relationship
·
has disclosed he/she intends to discuss off-label/investigative use of commercial
products/devices: list products/devices
As you can see you have the option of choosing sentence one or two and adding in the
company and relationship information OR choosing one or two and adding the NON-FDA
approved sentence if applicable. Please delete the statements that are not applicable to your
activity faculty
Example:
Dr. ________ has disclosed no relevant financial relationships but has disclosed he/she intends to discuss offlabel/investigative use of commercial products/devices: (list the product not the company, use generic names if
possible)
Dr. __________has disclosed a relevant financial relationship:
Consultant for xxxxxx
Speaker’s Bureau for xxxxx
Received honoraria for xxxxx and xxxxxx
and has disclosed he/she intends to discuss off-label/investigative use of commercial products/devices: (list the
product/device not the company)
Dr. ________ has disclosed no relevant financial relationships
Revised 10/2011