Consultant * *All conflicts of interest, including potential ones, must be resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. Section 5: Statement of Understanding Completion of the line below serves as the electronic signature of the individual completing this Biographical/Conflict of Interest Form and attests to the accuracy of the information given above. Signature: Name and Credentials (Required) Date Section 6: Conflict Resolution (to be completed by Nurse Planner) Procedures used to resolve conflict of interest or potential bias if applicable for this activity: Not applicable since no conflict of interest. Removed individual with conflict of interest from participating in all parts of the educational activity. Revised the role of the individual with conflict of interest so that the relationship is no longer relevant to the educational activity. Not awarding contact hours for a portion or all of the educational activity. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity. Other - Describe: Nurse Planner Signature (*If form is for the activity Nurse Planner, an individual other than the Nurse Planner must review and sign). Completion of the line below serves as the electronic signature of the Nurse Planner reviewing the content of this Biographical/Conflict of Interest Form. AHEC to sign here Typed or Electronic Signature: Name and Credentials (Required) Date
Consultant * *All conflicts of interest, including potential ones, must be resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. Section 5: Statement of Understanding Completion of the line below serves as the electronic signature of the individual completing this Biographical/Conflict of Interest Form and attests to the accuracy of the information given above. Signature: Name and Credentials (Required) Date Section 6: Conflict Resolution (to be completed by Nurse Planner) Procedures used to resolve conflict of interest or potential bias if applicable for this activity: Not applicable since no conflict of interest. Removed individual with conflict of interest from participating in all parts of the educational activity. Revised the role of the individual with conflict of interest so that the relationship is no longer relevant to the educational activity. Not awarding contact hours for a portion or all of the educational activity. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity. Other - Describe: Nurse Planner Signature (*If form is for the activity Nurse Planner, an individual other than the Nurse Planner must review and sign). Completion of the line below serves as the electronic signature of the Nurse Planner reviewing the content of this Biographical/Conflict of Interest Form. AHEC to sign here Typed or Electronic Signature: Name and Credentials (Required) Date
APHN%202015%20Call%20for%20Abstracts%20FINAL.docx