Form E – Letter of Agreement
Form E
Joint Providership Letter of Agreement
This Letter of Agreement is to confirm that the
____________________________________________________
is entering a “Joint Providership” relationship with
Icahn School of Medicine at Mount Sinai (ISMMS)
The Post-Graduate School for Continuing Medical Education
in order to develop the CME activity entitled:
___________________________________________________
to be held at:
___________________________________________________
(location)
on
__________________________________________________
(date)
Joint Providership is defined by the ACCME as the “Providership of a CME activity by one accredited
and one non-accredited organization.” The accredited provider must take the responsibility for a CME
activity when it is presented in cooperation with a non-accredited organization and must use the
appropriate accreditation statement (listed below). A Commercial interest cannot take the role of the
non-accredited entity in a joint providership relationship.” In a joint providership, each participating
organization has certain obligations and responsibilities. However, as the institution accredited by the
ACCME to approve this CME activity, Mount Sinai must require the following:
1. The ESSENTIALS of the Accreditation Council for Continuing Medical Education (ACCME)
and all ISMMS Guidelines on CME be met to the full satisfaction of the Mount Sinai CME
Advisory Committee.
2. All text of literature, brochures, and official correspondences must receive the written approval
of the Office of CME before publication or corrective action shall be taken, including withdrawal
of credit(s).
3. Mount Sinai must retain final approval rights for all program faculty and program content.
Form E – Letter of Agreement
4. All budgets for the activity – including but not limited to honoraria, reimbursements, tuition, and
grants – must receive prior approval from Mount Sinai’s Post-Graduate School and the CME
Advisory Committee.
5. All future use of this activity (e.g., “spin-offs” such as tapes, publications, computer programs,
etc.) can be distributed only with the prior approval and written consent of Mount Sinai and must
be included in the initial planning of the activity on which it is based.
6. Mass-marketing of the CME activity must receive the prior approval of Mount Sinai.
7. Jointly Providership accreditation statement:
“This activity has been planned and implemented in accordance with the accreditation
requirements and policies of the Accreditation Council for Continuing Medical
Education (ACCME) through the joint providership of the Icahn School of Medicine at
Mount Sinai and (name of non-accredited provider). The Icahn School of Medicine at
Mount Sinai is accredited by the ACCME to provide continuing medical education for
physicians.”
8. Adherence to Mount Sinai’s Policy for Identifying and Resolving Conflicts of Interest in CME
and all speakers/authors/moderators/planning committee members (i.e. anyone in the position to
control the content of the CME activity must complete the MSSM-CME Faculty Disclosure
Form (Form C). Any COI identified must be resolved.
9. Any “Enduring Material” related to this activity comply with the ACCME’s Standards regarding
enduring materials, and must be approved by the CME Advisory Committee.
10. If commercial support is received, the funding company sign Mount Sinai’s Letter-of-Agreement
(Form D), and that the activity meet ACCME’s Standards for Commercial Support of Continuing
Medical Education.
It is recognized and confirmed that both sponsors of this agreement have veto authority over the
educational content of the CME activity. The intent of this document is to articulate the responsibilities
Mount Sinai, as the ACCME accredited entity, must uphold. These accreditation responsibilities cannot
be transferred, delegated or compromised. Failure to comply with any of the terms and conditions in
this agreement may result in withdrawal of credit that is solely the discretion of Icahn School of Medicine
at Mount Sinai.
Please indicate with your signature, on behalf of your organization, that the above provisions are
understood and accepted as the basis of applying for Joint Providership with Icahn School of Medicine at
Mount Sinai.
_________________________
Name
_____
______
Alfie Truchan, Director, CME
_________________________
Title
__________________________
Date
_________________________
Organization
_________________________
Date