Are any sponsors represented on the planning committee? Application form: Part A - Question 8 compared with Part C - Question 1 Disclosure of conflicts Application form: ☐ Yes Part C - Questions 5 & 6 ☐ No ☐ Unsure Attachments: # 4 - Sample form and process for the collection, management, and disclosure of conflicts of interests Ethical standard 4: All funds received in support of the self-assessment program must be provided in the form of an educational grant payable to the physician organization. Application form: Part C - Question 4 Yes Attachments: No # 7 - The budget for this activity. Unsure # 9 - The sponsorship and/or exhibitor prospectus (if applicable). Ethical standard 5: No drug or product advertisements may appear on, or with, any of the written or presented materials for the self-assessment program. Attachments: # 1 – The preliminary program/brochure # 2 – The final brochure Yes No # 3 – Any other material to promote of Unsure advertise the activity # 9 - The sponsorship and/or exhibitor prospectus (if applicable) Ethical standard 6: Generic names must be used, or both generic and trade names, on all presentations and written materials. Application form: Yes Part C - Question 7 No
Are any sponsors represented on the planning committee? Application form: Part A - Question 8 compared with Part C - Question 1 Disclosure of conflicts Application form: Part C - Questions 5 & 6 Attachments: # 4 - Sample form and process for the collection, management, and disclosure of conflicts of interests ☐ Yes ☐ No ☐ Unsure Ethical standard 4: All funds received in support of the self-assessment program must be provided in the form of an educational grant payable to the physician organization. Application form: Part C - Question 4 Attachments: # 7 - The budget for this activity. # 9 - The sponsorship and/or exhibitor prospectus (if applicable). Yes No Unsure Ethical standard 5: No drug or product advertisements may appear on, or with, any of the written or presented materials for the self-assessment program. Attachments: # 1 – The preliminary program/brochure # 2 – The final brochure # 3 – Any other material to promote of advertise the activity # 9 - The sponsorship and/or exhibitor prospectus (if applicable) Yes No Unsure Ethical standard 6: Generic names must be used, or both generic and trade names, on all presentations and written materials. Application form: Part C - Question 7 Yes No
provider-template-reviewer-report-sim-activities-e.docx