Office of Continuing Medical Education
1462 Clifton Road, NE, Suite 276
Atlanta, GA 30322
404-727-5667 (fax)
Dear Faculty,
Thank you for agreeing to speak at the upcoming __________________________________
Please refer to the attached brochure for your scheduled presentation(s) and plan to arrive
accordingly. This activity has been planned for an audience of _______________________ The
purpose of your contribution is to ________________________________________ at all levels
of practice the latest objective information related to your presentation.
Conflict of Interest
As an accredited CME sponsor, Emory University School of Medicine requires that its speakers
comply with the ACCME Standards of Commercial Support of CME. These Standards require
the disclosure of the existence of any financial relationship you may have with any commercial
producer of healthcare related goods or services within the last 12 months. This includes salary,
royalty, intellectual property rights, honoraria and consulting fees. On the basis of the
information you provide on the attached Financial Relationship Disclosure form, we will 1)
determine if a conflict of interest exists, 2) utilize the information to resolve the conflict by
initiating the resolution process and 3) inform the audience of relevant financial relationships.
To accomplish this, Please complete and return the attached Financial Disclosure form no
later than ________________ so that we may confirm your continued participation in this event.
Please note that new rules mandated by the ACCME require that we disqualify those who
do not supply this information to us in a timely manner. To ensure your participation in the
symposium, please forward the form to me no later than __________.
Handout / Syllabus Material
As part of the learning experience, a conference syllabus will be given to each attendee
containing supplemental materials. Educational materials, such as slides, abstracts and other
handouts cannot contain any advertising, trade names or product-group messages. Materials to
be included in the syllabus are due to me ____________________________. Copyrighted or
previously published materials must be accompanied by permission grants from the publisher
and author in order for Emory University to reprint. We prefer that handouts not be distributed
outside of the bound syllabus. Slide presentations are acceptable and can be emailed to
____________________ If file size is very large, feel free to mail digital or hard copy to
________________________, CME, 1462 Clifton Rd., Suite 276, Atlanta, GA 30322. If hard
copy, please print slides 6 per page.
Evaluations
It is the policy of the Office of CME to conduct post-activity evaluations. These evaluations ask
participants to indicate the appropriateness of presentations to their specific practices; if the
presentations satisfied the stated objectives; if the presentation of the material was fair and
balanced; if they were satisfied with the faculty presentations; and if there was any evidence of
commercial bias. The results of these evaluations are used to plan future CME activities and are
shared with the faculty.
Attestation Statement 3/2012
Attestation:
1. I understand that I am required to disclose any relevant financial relationships
to the audience at the beginning of my presentation, both by projection and verbally.
2. I agree to provide learning objectives by projection at the beginning of my presentation.
3. If presenting specific patient cases or case histories, I warrant that I have HIPAA
compliant authorization for any Protected Health Information in the presentation
materials or have de-identified all materials.
4. I agree that will not accept any honoraria, additional payments or reimbursement beyond
that which has been agreed upon specifically with the Emory School of Medicine or its
designee.
5. I agree that the content of my presentation will be therapeutically well-balanced,
evidence-based, non-biased and any recommendations involving clinical medicine will be
based on evidence that is accepted within the profession of medicine as adequate
justification for their indications and contraindications in the care of patients.
6. All scientific research referred to, reported or used in my presentation in support or
justification of a patient care recommendation must conform to the generally accepted
standards of experimental design, data collection and analysis and will not promote the
commercial interest of the funding company.
7. If I am discussing specific healthcare products or services, I will use generic names to the
extent possible. If I need to use trade names, I will use trade names from several
companies when available and not just names from any single company.
8. I understand that if I fail to give a balanced and objective presentation, as determined by
the audience and/or CME meeting planning committee, I will either
a. Be required to submit the content (slides, etc.) of any future educational
presentations to the Emory CME Meeting Planning Committee before the
presentation may be approved, or
b. Be prohibited from presenting educational sessions at future Emory CME
programs.
9. I verify that prior to the presentation, I have requested and/or obtained permission from
copyright holder(s) to reproduce/copy, from their work, the portions of my presentation
that are protected by copyright laws. I acknowledge that Emory University School of
Medicine will not be held legally responsible for any misrepresentation on my part
regarding copyright infringement.
Signed: ___________________________ Date: _________________________________
Print Name: _____________________________________________________________
Attestation Statement 3/2012