Please provide the following details for each relationship:
1. Enter the name of the Ineligible Company: An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. For specific examples of ineligible companies visit accme.org/standards.
2. Enter the Nature of Financial Relationship: Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.
3. Has the Relationship Ended: If the financial relationship existed during the last 24 months, but has now ended, please enter"Yes" in this column. This will help the education staff determine if any mitigation steps need to be taken.