your disclosure statement

Of particular note this year is a rule change by ACCME regarding standards for commercial
support, specifically:
Standard 4.3: Educational materials that are part of a CME activity, such as slides, abstracts
and handouts, cannot contain any advertising, corporate logo, trade name or a productgroup message of an ACCME-defined commercial interest.
Disclosure of commercial support must never include the use of a trade name or a product-group
message of an ACCME-defined commercial interest. Acknowledgment of commercial support
may state the name, mission, and areas of clinical involvement of an ACCME-defined commercial
interest but may not include corporate logos and slogans.
Please keep this in mind when preparing your presentation
ACCME definition of a commercial interest: A commercial interest is any entity producing,
marketing, re-selling, or distributing health care goods or services consumed by, or used on,
patients. ACCME does not consider providers of clinical service directly to patients to be a
commercial interest.
For full details, please visit:
Select ONE of the next two slides for your presentation. Feel free to
use your own background design for the slide. Delete the red-lined
boxes once you have decided which slide to use.
Per APM Policy and in keeping with ACCME Guidelines, APM authors
and speakers are expected to:
• Disclose to APM and meeting attendees the existence of any
financial relationships with any for-profit companies that are
directly or indirectly related to the subject of their presentation (or
the lack of such relationships) within the past 24 months through
disclosure forms and session materials.
• Note whether any of the financial relationships are relevant to the
presentation being planned.
• Work with APM to ensure that any conflicts of interest are resolved
prior to the start of the presentation.
Use this slide template when financial disclosure is necessary
APM 2014
Disclosure: FName LName, MD
Company A
Company B
Company C
Company D
Independent Contractor
Speaking & Teaching
Board, Panel or Committee
D – Relationship is considered directly relevant to the presentation
I – Relationship is NOT considered directly relevant to the presentation
Note: Portions of the grid that are not needed can be grayed out. A good example
might be when less than four companies are involved
Use this slide template if there is nothing to disclose
APM 2014
Disclosure: FName LName, MD
With respect to the following presentation,
there has been no relevant (direct or indirect)
financial relationship between the party listed
above (and/or spouse/partner) and any forprofit company in the past 24 months which
could be considered a conflict of interest.

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