Reviewer Disclosure

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It is the policy of the American Society of Echocardiography (ASE) Continuing Medical Education Program to ensure balance, independence, objectivity and scientific rigor in all its sponsored or jointly sponsored educational activities. All faculty participants bearing on the subject matter of the presentation topic, including relationships with biomedical devise manufacturers, or other pharmaceutical identification and trade name of drugs so as to avoid the appearance of commercial bias. Use of the aforementioned identification material will be viewed as a violations against the Essentials and Standards of the ACCME, compromising the scientific balance of the program and offering bias to the presentation. The intent of this policy is not to prevent a speaker with a potential conflict of interest from making a presentation. It is merely intended that any potential conflict should be identified openly and resolved prior the activity.
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Instructions
Disclosure of Financial Relationships
ASE policy requires review of disclosure information for potential conflicts and interest and resolution mechanisms that will eliminate the potential perception of bias with respect to your role in this CME activity. The potential for bias occurs when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. To the subject matter of their assignments, the ACCME defines a commercial interest as any entity producing, marketing, re*selling or distrubuting health care goods or services consumed by or used on, patients, with the exception of nonprofit or government organizations and non-health care-related companies. Providers of dinical services directly to patients are no considered a commercial interest.
Within the past 12 months, I and/or my spouse/significant other have received support from or had a relationship with the following commercial interests (indicate all that apply) that may have a direct bearing on the subject matter of my presentation topic(s). Disclosure should include relationships in any amount.
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I have no disclosure to make.I have the following relationships to report:
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Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationCorporate research collaboration (including trials/product testing)EmploymentOther
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Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationRoyalty, PatentsCorporate research collaboration (including trials/product testing)EmploymentOther
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Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationRoyalty, PatentsCorporate research collaboration (including trials/product testing)EmploymentOther
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Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationRoyalty, PatentsCorporate research collaboration (including trials/product testing)EmploymentOther
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Company #5 Relationship
Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationRoyalty, PatentsCorporate research collaboration (including trials/product testing)EmploymentOther
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Check all that apply.Speaker/Speakers' BureauConsultant, AdvisorStock Ownership (not including stocks owned in a management portfolio)Research grant (including grants in which you are listed PI)Spouse Employment AffiliationRoyalty, PatentsCorporate research collaboration (including trials/product testing)EmploymentOther
Agreement
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I understand that the information presented to the learner must be unbiased, scientifically balanced, and based on best available evidence and best practices in medicine. I agree to present all reasonable clinical alternatives when making practice recommendations. I attest that relationships with commercial interests will not influence or bias my presentation and/or planning of the CME activity.YesNo
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I agree to disclose when products/services are not labeled for the use under discussion or when the products are still under investigationYesNo
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All scientific research referred to, reported, or used in support or justification of patient care recommendations will confirm to the generally accepted standards of experimental design, data collection, and analysis.YesNo
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