Disclosures to Participants
Texas Hospital Association
Provider-Directed
Activity Title: The 2012 CMS Condition of Participation Webinar Series
Date:
June 7, 14, 21
Location:
3-Part Webinar Series
Accreditation Statement:
The Texas Hospital Association is an approved provider of continuing nursing education by the Texas Nurses Association, an
accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Criteria for Successful Completion
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Organization/Individual Registration is required for verification of continuing education credit.
To receive contact hours for this activity, participants should claim credit commensurate with only those sessions attended
in their entirety and complete the web based Evaluation tool within one week following the program.
Following completion of the evaluation and once successful completion has been verified, a “Certificate of Successful
Completion” will be awarded for 2.0 contact hours per session.
The learning goal/purpose of this educational activity is: Comply with the 2012 CMS Conditions of Participation.
The objectives of this educational activity are:
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Please refer to evaluation tool
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Conflicts of Interest:
A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a
commercial interest or a potentially biasing relationship of a financial, professional or personal nature. All planners and faculty/content
specialist(s) must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to
the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and
faculty/content specialists have submitted Conflict of Interest Disclosure forms.
The planning committee members and faculty/content specialists of this CNE activity have disclosed NO relevant
professional, personal financial relationships related to the planning or implementation of this CNE activity.
-ORThe planning committee members and faculty/content specialists of this CNE activity have disclosed THE FOLLOWING
relevant professional, personal financial relationships related to the planning or implementation of this CNE activity:
Name
Company
Conflict
Resolution
(employment, leadership position, research funding,
consultant/advisory board, speaker’s bureau, stock holder)
(mechanism to identify and resolve conflicts
of interest)
Off-label Use
This activity
DOES
DOES NOT include information about off-label use of any product for a purpose other
than that for which it is approved by the U.S. Food and Drug Administration (FDA).
Explanation of off-label use of the following product(s):
Sponsorship or Commercial Support
This CNE activity received no sponsorship or commercial support. Texas Hospital Association Corporate
Sponsorship funds have not been applied directly to this continuing education activity.
This CNE activity has received the following sponsorship(s) and/or commercial support (blank if there is no
sponsorship and/or commercial support):
Name(s) of Company
Type of Support
TNA Provider Revision: April 2010
THA Review/Revision: Jan 2012
Non-Endorsement of Products
Approved provider status of the Texas Hospital Association only to recognition of the continuing education activity and does
not imply a real or implied endorsement by the Texas Hospital Association (THA), the American Nurses Credentialing Center’s
Center (ANCC) or the Texas Nurses Association (TNA) of any commercial product, service, or company referred to or
displayed in conjunction with this activity, nor any company subsidizing costs related to this activity.
Reporting of Perceived Bias
Bias is defined by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) as preferential
influence that causes a distortion of opinion or of facts. Commercial bias may occur when a CNE activity promoted on or more
product(s) (drugs, devices, services, software, hardware, etc.). This definition is not all inclusive and participants may use
their own interpretation in deciding if a presentation is biased.
The ANCC COA is interested in the opinions and perceptions of participants at approved CNE activities, especially in the
presence of actual or perceived bias in continuing education. Therefore, ANCC invites participants to access their “ANCC
Accreditation Feedback Line” to report any noted bias or conflict of interest in the educational activity. The toll free number is
866/ 262-9370.
FOR APPROVED PROVIDER USE ONLY
Attestation
If any or all of the above information was disclosed verbally to participants, a representative of the CNE Approved Provider
Unit must attest that the disclosure did occur.
I,
, attest that the above information was disclosed to the continuing education activity participants.
______________________________________________
Signature
_________________
Date
Written/signed documentation is provided in the CNE Activity file.
TNA Provider Revision: April 2010
THA Review/Revision: Jan 2012