Relevant Financial Disclosure(s) <insert speaker name> - - PowerPoint PPT Presentation

Relevant Financial Disclosure(s)

Directions: 1) Insert your name above. 2) Choose the disclosure statement that reflects your disclosure status 3) Delete the other option and all RED text If NO relevant financial relationships exist, use this statement:

• I have nothing to disclose

If ANY relevant financial relationships exist, list the following for each commercial interest:

• <insert name of commercial interest>
• <insert role (i.e. speaker, advisory board member, consultant)>
• <insert what was received? (i.e. honoraria, consultant fees, grant

funding)>

1

<insert speaker name>

(Example 1)

Relevant Financial Disclosure(s)

• I have nothing to disclose

2

Jane Doe, MD

(Example 2)

Relevant Financial Disclosure(s)

• Company 1
• Speaker
• Speaker fee
• Company 2
• Advisory board membert
• Consultant fee

3

John Doe, MD