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AOSSM Full Disclosure Statement Form
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The intent of this disclosure is not to prevent a participant with significant
financial or other relationship from making a presentation, but rather to
provide participants with adequate information to make their own judgments.
Conflict of Interest
The American Orthopaedic Society for Sports Medicine (AOSSM) is a provider
accredited by the Accreditation Council for Continuing Medical Education
(ACCME) and is required to identify and resolve all potential conflicts of
interest with any individual (or their spouse/partner) in a position to
influence and/or control CME activities. A conflict of interest will be
considered to exist if the individual has received financial benefits (e.g.,
grants, research support, honoraria, employee, consultant, board of directors,
stockholder) in any amount from a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients)
within the past 12 months and that individual is in a position to affect the
content of CME regarding the products or services of the commercial interest.
All individuals in a position to influence and/or control the content of AOSSM
sponsored CME activities are required to disclose to the AOSSSM and
subsequently to learners that the individual either has no relevant financial
relationship or any financial relationship with the manufacturer(s) of any
commercial product(s) and/or providers of commercial services discussed in CME
activities. All disclosure information provided to AOSSM will be reviewed to
ensure that no conflicts of interest exist prior to the confirmation of the
individual for the educational assignment. Additional information may be
requested. It is the responsibility of the individual to notify AOSSM of any
changes in the disclosure information provided since the submission of this
AOSSM Full Disclosure Statement Form.
To view the ACCME’s full policy on the Updated Standards of Commercial Support,
please click here (www.accme.org/dir_docs/doc_upload/68b2902a-fb73-44d1-8725-80a1504e520c_uploaddocument.pdf)
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HAVE ANY FINANCIAL RELATIONSHIPS WITH ANY COMMERCIAL INTERESTS |
| If you answered "yes" please list the company and your relationship below. Click
"Add Company" to add additional companies to the list. If a company is not listed,
please click "other" for company and then add company name in the comment field. |
| | Company | Role | Comment | Status | Edit Command |
| e0d709cd-450f-421f-a19a-4c609a0df5e5 | 1 | TORNIER | LICENSEAGREE | Total Elbow | A | |
| 6991b9b1-8d9f-4534-9037-e767aec4e278 | 1 | OTHER | LICENSEAGREE | Acumed/Elbow Plate & Radial Head | A | |
| 2da8ff43-f03b-4cad-8fed-a37c9d4c43da | 1 | OTHER | LICENSEAGREE | Aircast/Elbow Brace | A | |
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I agree
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I understand failure or refusal to disclose within the established timeframe
will require AOSSM to identify a replacement. I will uphold AOSSM standards to
ensure balance, independence, objectivity and scientific rigor in my role in
planning or presentation of AOSSM’s CME activity. |
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I agree
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Disclosure of Off-Label (Unappoved/Investigational) Uses of Products
AOSSM CME faculty are required to disclose to AOSSM and to learners when they
plan to discuss or demonstrate pharmaceuticals and/or medical devices that are
not approved by the FDA and/or medical or surgical procedures that involve an
unapproved or “off-label” use of an approved device or pharmaceutical.
I understand and agree to abide by FDA regulations and will clearly delineate
utilization of “off label” use of drugs or devices for the audience.
To view the FDA policy on Disclosure of Off-Label product use, please click
here (www.fda.gov/cder/mapp/4550.5.pdf)
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