GOS 2025 Annual Meeting Disclosure Form

Georgia Orthopaedic Society
2025 Annual Meeting
September 25-28, 2025

DADE COUNTY MEDICAL ASSOCIATION:
CME DISCLOSURE FORM FOR PLANNERS, REVIEWERS, FACULTY, AND AUTHORS

All persons who influence the content of CME activities are required to disclose all financial relationships with any ineligible companies. This includes planners, activity directors, presenters, authors, and administrative staff who participate in the design and development of content, as well as CME Committee members and reviewers who vet and approve proposed content. The intent of this form is to inform planners/presenters/ reviewers of their obligations and to support the DCMA in mitigating all financial relationships with ineligible companies, thus assuring balance, independence, objectivity and scientific rigor in all accredited content.

Name*

First NameLast Name

Your Role:*

PlannerActivity DirectorPresenter/AuthorReviewer

Title of Activity/Topic:*

Mitigation Needed?

Mitigation Taken

Activity Date*

Date

Date this form completed:*

Date

Check here if completing this form as a CME Committee member or reviewer for a calendar year.

CME Committee member/Reviewer

Check the appropriate box below and provide an explanation in the space(s) provided if you answer "Yes":

Do you (now or within the past 24 months) have a financial relationship with an ineligible company?**

YesNo

*You must disclose ALL financial relationships regardless of your view of their relevance to the content being planned/presented.

Financial Relationship

	Ineligible Company	Check if the relationship has ended
Employee/Owner
Grant/Research Support
Consultant
Speaker's Bureau
Other Financial/Material Support (describe)
Stock Owner/Investor, privately held company:
Stock Owner/Investor, publicly traded company:
Advisory Board Member

By checking this box and submitting this form, you agree to comply with the following conditions:*

I agree

1. If I have reported a financial relationship with an ineligible company, I understand that this information will be reviewed to determine whether this relationship precludes my participation, and I may be asked to provide additional information.

2. I will update my disclosure information should anything change.

3. Failure/Refusal to disclose, false disclosure, or inability to mitigate COI will disqualify me from participating in this activity.

4. I will support my presentation and clinical recommendations with the best available evidence from current medical literature. All scientific research referred to, reported or used in support or justification of patient care recommendations will conform to the generally accepted standards of experimental design, data collection and analysis.

5. I will give a balanced view of ALL therapeutic options and use generic names when discussing pharmaceutical products.

6. I will not advocate for or promote practices that are not, or not yet, adequately based on current science, evidence and clinical reasoning.

7. I will disclose unlabeled use of a product or an investigational use of a product not yet approved by the FDA.

8. I have not nor will I accept any honorarium/special payments from ineligible companies for my participation in this activity.

9. I will not promote or sell products (e.g. books) or services that serve my professional or financial interests during my presentation.

Sign/type your name:*

GLOSSARY OF TERMS:

- INELIGIBLE COMPANY is defined as any entity whose primary business is producing, marketing, selling, re-selling, or distributing health care goods or services used by or patients. Entities that provide clinical service directly to patients are exempted.

- FINANCIAL RELATIONSHIPS are defined as those in which a person benefits by receiving a tangible financial benefit (e.g., salary, royalty, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds). Financial benefits are usually associated with roles such as employment, management positions, independent contractor, consulting, speaking and teaching, membership on advisory committees or review panels, board memberships, and other activities from which remuneration is received, or expected.

- RELEVANT financial relationships are those in any amount occurring within the past 24 months where the planner or speaker has the opportunity to influence CME content that relates to the products or service lines of the ineligible company with which he/she has a financial relationship. The DCMA as the accredited provider is obligated to determine relevance. And the DCMA as the accredited provider is obligated to mitigate all financial relationships determined to be relevant.