Quality continuing education activities depend on thoughtful and rigorous planning. The following section asks you to describe and demonstrate how your activity will directly contribute to health care improvement while meeting the current CME guidelines and requirements of the ACCME, ACPE, and ANCC.

Note: Employees of an ACCME defined commercial interest organization are not allowed to participate in the planning of an accredited activity.  This includes the identification / selection of speakers or topics. A commercial interest is defined as an entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on patients.  Initial the following box to document that you have read this statement and that you attest that the activity’s planning was done free of commercial influence.  

http://www.accme.org/requirements/accreditation-requirements-cme-providers/policies-and-definitions/financial-relationships-and-conflicts-interest

All CME Planners and Speakers /Moderators/Discussants/Authors/Editors involved in the development and/or presentation of CME content must complete this form. The form must be updated whenever circumstances require it.

Failure or refusal to disclose or the inability to manage the identified conflict will result in the withdrawal of the invitation to participate.

If you do have a financial relationship(s) with commercial interests:

· List the names of companies that you (or your Spouse/Partner) have a financial relationship with currently or have had in the last 12 months.

· Explain what you (or your Spouse/Partner) received (i.e. salary, honorarium, etc.).

· Specify your role (i.e. consultant, board member, etc.)