• Disclose to APM and meeting attendees the existence of any Disclose to APM and meeting attendees the existence of any financial relationships with any for-profit companies that are financial relationships with any for-profit companies that are directly or indirectly related to the subject of their presentation directly or indirectly related to the subject of their presentation (or the lack of such relationships) within the past 24 months (or the lack of such relationships) within the past 24 months through disclosure forms and session materials.through disclosure forms and session materials.

• Note whether any of the financial relationships are relevant to Note whether any of the financial relationships are relevant to the presentation being planned.the presentation being planned.

• Work with APM to ensure that any conflicts of interest are Work with APM to ensure that any conflicts of interest are resolved prior to the start of the presentation.resolved prior to the start of the presentation.

Note: This file consists of 3 slides. After reading this first slide, select ONE of the next two slides for your presentation. Feel free to

use your own background for the slide.

Per APM Policy, and in Keeping with ACCME Guidelines, APM Authors and Speakers are Expected to:

APM 58th Annual Meeting

Disclosure: Joseph Smith, MD Company A Company B Company C Company D

D

I

D

I

CompanyEmployment

Management

Independent Contractor

Consulting

Speaking & TeachingBoard, Panelor CommitteeMembership

Use this slide template when financial disclosure is necessary…

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.

D – Relationship is considered directly relevant to the presentation.I – Relationship is NOT considered directly relevant to the presentation.

APM 58th Annual MeetingDisclosure: Joseph Smith, MD

With respect to the following presentation, there With respect to the following presentation, there has been no relevant (direct or indirect) has been no relevant (direct or indirect)

financial relationship between the party listed financial relationship between the party listed above (and/or spouse/partner) and any for-profit above (and/or spouse/partner) and any for-profit company in the past 24 months which could be company in the past 24 months which could be

considered a conflict of interest.considered a conflict of interest.

Use this slide template if there is nothing to disclose...