Presenter Slide Template Instructions 1 The following slides

Presenter Slide Template Instructions 1. The following slides can be used to create your disclosure statement. 2. Delete the two instructions slides once complete. 3. The text in blue font should be updated by the presenter. Text in black font should remain on the slide 4. Use your own slide background. 5. Below are the categories of relationships to include on your disclosure slide. Only reference a category if you have a disclosure to report. 1. Employment by commercial entity 2. Consultancies 3. Advisory Board 4. Lecture fees paid by a commercial entity (honoraria) 5. Expert witness for a commercial entity 6. Industry-sponsored grants (received or pending) including contracted research 7. Patents received or pending 8. Royalties from a commercial entity 9. Stock ownership or options (other than mutual funds) 10. Other

The following disclosures are required of moderators and presenters relevant to the session in which they are speaking: 1. Disclosure of personal relationships with a commercial interest if both (a) the relationship is financial and occurred within the past 12 months, and (b) the individual has the opportunity to affect the content of CE about the products or services of that commercial interest. ACCME definitions: Commercial interest is any proprietary entity producing health care goods or services consumed by or used on patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. Financial relationships [with a commercial interest] are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest [e. g. stocks, stock options or other ownership interest, excluding diversified mutual funds] or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor [including contracted research], consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. ACCME considers relationships of the person involved in the CE activity to include financial relationships of a spouse or partner. The ACCME has not set a minimum dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. 2. Disclosure of any discussion in the presentation of “off-label” (unapproved) use of substances/products not approved in the United States for the use under discussion. APHA requires such disclosure to assist participants in CE activities to be consistent with U. S. Food and Drug Administration Guidance for Industry: Industry-Supported Scientific and Educational Activities

Presenter Disclosures Presentation Title 1. The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Instructions for responding to statement 1: • If you have no disclosures to make, type “No relationships to disclose” • If you have disclosures to make include the Category of Relationship as provided in slide instructions and follow with the name of each commercial interest (company) disclosed. o Use separate paragraphs with bullets for each Category of Relationship o Continue on a second slide if needed.

Presenter Disclosures Presentation Title 2. My presentation will include discussion of “off-label” use of the following: Instructions for responding to statement 1: • If you have no disclosures to make on discussion of “off-label” use, you may omit this slide. • If you have off-label disclosures to make, include the name of the commercial product (use generic name rather than brand name), followed by the nature of the off-label use discussed. • Use separate paragraphs with bullets for each separate “off-label” disclosure, if any.