Department of Continuing Medical Education WRITTEN DOCUMENTATION OF LIVE MEETING MONITORING OF DISCLOSURES OF FINANCIAL SUPPORT AND/OR DISCUSSION OF UNLABELED OR INVESTIGATIONAL USEPlease complete the following form as soon as possible following the moderated session. Activity Details Activity Type Location Session Title * Activity Date * - Select -Friday, March 24, 2023Saturday, March 25, 2023Sunday, March 26, 2023 Speaker's Name * Monitoring Questions 1. I detected commercial bias from the speaker in favor of the following product(s), device(s) and/or company(ies) in this presentation. * No Yes If "Yes", provide Product/Company name: * 2. The speaker discussed unlabeled use and/or investigational product * (Ensures that discussion of content is balanced and consistent) No Yes If "Yes", provide Product(s)/ Drug(s) name(s): * 3. Unusual happenings during meeting? * (Ensures that promotional statements are excluded) No Yes If "Yes", provide details: * 4. Speaker(s)/ Moderator(s) verbally disclosed sources of funds from commercial supporters? * Yes No This Session is Not Commercially Supported 5. Speaker(s) disclosures (faculty relationships) were shared with the audience in slide presentation +/or verbally by speaker and/or moderator? * Yes No 6. This presentation met the following Competencies: (Check all that apply) ABMS/ACGME Competencies Patient Care Medical Knowledge Systems-Based Practice Professionalism Communication Skills Practice-Based Learning and Improvement Interprofessional (IP) Education Collaborative Competencies Values/Ethics for IP practice IP Communication Roles and Responsibilities Teams and Teamwork IOM Competencies Patient-Centered Care Evidence-Based Practice Interdisciplinary Teams Use of Informatics By entering my name below I confirm I have completed this form honestly and to the best of my ability Staff Name * Today's Date * Leave this field blank
