Joint Providership State Chapter CME Activity
Disclosure Report for Participant Notification
State Chapter Name
Activity Name
Activity Date & Location
Statement of Disclosure
It is the Non-Accredited State Chapter’s responsibility to collect ALL disclosures and submit them
to the ASMBS prior to planning. All faculty/speakers, planners, abstract reviewers, moderators,
authors, co-authors and administrative staff participating in the continuing medical education programs
sponsored by the ASMBS are expected to disclose to attendees any/all relevant financial relationships
related to the content of their presentation(s) in accordance with ACCME Guidelines for Commercial
Support.
Last
Name
First
Name
Email
White
Teresa teresa@asmbs.org
Activity
Role
Company
Name(s)
What was
Received?
For What Role?
Admin
15
i.
CPD Compliance
Resolution Key
R1-Restricted to best available evidence & ACCME content validation statement
R2-Removed/altered financial relationship
R3-Altered control
R4-Peer review with altered financial relationship
R4NC-Peer review and no conflict found
N/A-No conflict
Conflict
of
Interest?
No
Conflict
Resolution
N/A
Commercial Interest
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AAFP
Abbott
Abbott Nutrition
ACS/MBSAQIP
Advisory Board Co.
Aesculap
Affinergy
Allergan
Allergy & Immunology
American Academy of
Asthma
American College of Surgery
Amylin
Analytica International
Applied Medical
Arena Pharmaceuticals
Ascent
ASMBS
ASMBS Foundation
AspenBio Pharma Inc
AstraZeneca
Australian Inst-Wt. Control
Avare
B Braun
Bard/Davol
Bari MD
Bari Sense
Bariatec Corporation
Bariatric Advantage
Bariatric Fusion, Inc
BAROnova
Barosense
Bate
Baxter Germany
Baxter Healthcare Corp
Betastim LTD
Beverage Institute for Health
& Wellness
BLIS Inc.
Boston Scientific
Cambridge Endo
Cardica
Cardinal Health
Carefusion
Catalina Lifesciences, Inc.
Celebrate Vitamins
Centralfix
Chike Nutrition
Cine-Med.
Cline
ConMed Linvatec
Cook
Cook Biotech
Covidien
CR Bard
Cryolife
Cubist
Daiichi-Sankyo
Davol/Bard
Duke Univ. Med. Ctr.
EDLO
Eli Lilly
Elsevier
Emmi Solutions
EMS
Endo Surgery
Endocore
Endogastric Solutions
EndoMetabolic Solutions
EnteroMedics
Ethicon EndoSurgery
ExploraMed
Fresinius Kabi
Fulfillium Inc.
Gelesis
GI Dynamics
GlaxoSmithKline
76.
77.
78.
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146.
147.
Henried
Hill Rom
Hourglass Technologies
Human Performance
Institute
I Flow
Iasis Health Care, LLC
Immersion
InDelta Learning
Info-Surge, Inc.
Integrated Medical Systems
Intuitive Surgical
Ispen Biomeasuer
Johnson & Johnson
Johnson Medical Products
Kaiser Permanente
Karl Storz Endoscopy
L3
Lifecell
Litholink
Marmara University
Research
MCNeil
Medingo, Insuline,Nanopass,
Andromeda, Healor
Medtronic
Melsosa LLC
Merck
Metacure
Metagenics
MSD
National Association for
Weight Loss Surgery
National Institute of Health
Nestle
NIH/NIDDK
Nora Therapeutics
NOSCAR
Novaptus Systems
Novare
Novartis
Novo Nordisk
Novus RRG
Nutrisystem
NY Presbyterian Hosp
Obesity Action Coalition
Obesity Surgery
Olympus
Optum Health
Orexigen
Pantax
Pearson
Pfizer
Physability, Inc.
Physicians Review of Surgery,
LLC NGM Bioteck
Power Medical Intervention
Prosynthesis
RemedyMD
Robard
Realize mySuccess
ResMed
Rhythm Pharmaceuticals
Sanofi-Aventis
Santinov
Satiety, Inc.
Schering Plough
Scientific Intake
Skylex Advanced Surgical, Inc
SOARD
Solvay Pharma
Southeast Georgia Health
System
Stevens & Lee
Storz
Strativa
Stryker Endoscopy
Surgical Excellence
148.
149.
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210.
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215.
216.
217.
218.
219.
Surgical Review Corporation
Surgiquest
SurgRX
SuturTek
Synergy Bariatrics
Synovis
Takeda NA
The Petkus Group
Ther-RX
TransEnterix
University of Minnesota
USGI Medical
ValenTx
Valleylab
Vibrynt
Vivus
WL Gore & Associates
Wyeth
NGM Biotech
Roche
RXI Pharmaceuticals
Apollo
Alacer Biomedica
Bariatrix (Nutritional)
Center for Medical
Weightloss
Independent Data
Monitoring
King Pharmaceuticals
Multicare Health System
Partners Healthcare
Reshape
CAVU
Miret Surgical
Roche
NGM Biotech
Vysera
Beacon Edoscopic
James Bell Associates
Cisco Systems.
Obesity Taskforce
NIOSH, CDC
Spark Medical LLC
Surgical Excellence
Lindstrom Healthcare
Advocacy
Virtual Port
Cropson
The Davis Clinic
Endostim.
Bariatric Times
Gynzyme
University of Pittsburgh
Spark Medical
Mitre
National Association for WLS
Advanced Weightloss
Solutions
MetaProteomics
Atkins Foundation
ASPIRE
Dannon/Yakult
DSM Nutrional
Barnes-Jewish Hospital
Foundation
Kilo Foundation
RTI International
ArborMetrix
SHIRE
Weight Watchers
International
Cadence Pharmaceuticals
Blue Cross Blue Shield
BrainSonix
Brainsway
Cephos
MECTA
Neuronetics
220.
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258.
259.
260.
261.
262.
Vindico
LifeScan
Ethicon Products
Safestitch
Exemplo Medical
LipoScience
NINDS
ASGE
TIF Management, LLC
Obalon Theraputics
Outcome
Puget Sound Medical Center
Taipei Medical University
Etna Interactive
Scottsdale Healthcare
Puget Sound Surgical Center
TIF Management LLC
Apollo Endosurgery
Satiety, Inc.
BLIS Inc.
Safestitch Inc
Crospon
AHRQ
University of Washington
Teleflex
BSM Consulting
Precision Health Economics
Campbell Alliance
BBC Services
InfoSurge, Inc
CVRx
Binks Behavioral Health PLLC
New Hope Wellness & Total
Bariatric Care
Springer Publisher
Michelle May, MD – Am I
Hungry.com
AMAG
MedXCom
JandJees
Eisai
MedImmune
Zafgen
Fractyl
EndoSense
Received by Faculty:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
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v.
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x.
Advisory Committee
Board
Clinical Trial Contract
Consulting Fee
Consulting Honoraria
Council
Editorial Board
Education Grant
Employment
Honoraria
Other
Ownership Interest
Proctor
Research
Research Grant
Research Honoraria
Royalty
Salary
Site Review
Speakers Bureau
Support
Teaching Grant
Teaching Honoraria
Training