Please complete and submit this form prior to the deadline, March 3, 2025 11:59 PM PST.

FULL DISCLOSURE OF FINANCIAL and NONFINANCIAL RELATIONSHIPS:
The CGC and CME partners adhere to the Standards for Commercial Support of the Accreditation Council for Continuing Education (ACCME). It is the policy of the CGC and CME partners to ensure balance, independence, objectivity, and scientific rigor in all its individually sponsored or jointly sponsored/co-provided educational activities.

ATTENTION: Please disclose all financial relationships that you have had in the past 24 months with ineligible companies (see definition below). For each financial relationship, enter the name of the ineligible company and the nature of the financial relationship(s). There is no minimum financial threshold; we ask that you disclose all financial relationships, regardless of the amount with ineligible companies. You should disclose all financial relationships regardless of the potential relevance of each relationship to the education. 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. The ACCME/ANCC does not consider providers of clinical service directly to patients to be ineligible companies unless the provider of clinical service is owned, or controlled by, an ACCME/ANCC-defined ineligible company.

In the past 24 months, have you had any financial relationships with any ineligible companies?
NO: If NO, see AGREEMENTS below.
YES: If YES, please list your DISCLOSURE and APPROACHES TO RESOLUTIONS, below.

DISCLOSURE: Nature of Relevant Financial and Nonfinancial Relationship(s) – include all relationships, relevant to the course content, including any mentioned in your bio. An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME does not consider providers of clinical service directly to patients to be ineligible companies - unless the provider of clinical service is owned, or controlled by, an ACCME-defined ineligible company.

Please give the following information for each relationship:

Name of company or organization
a) What have you received from the company or organization? (Salary, stock, honoraria, consulting fee, intellectual property rights, book royalties, ownership interest, etc.)
b) What type of relationship do you have with the organization? (Speaking/teaching, member of an association that is referenced in the course, family member or friend with the disorder discussed in the course, membership on advisory or review panels, chairing a related voluntary committee, etc.)

Example #1
Name of Pharma / Device Manufacturer
a) Honoraria
b) Speaker

Example #2
Name of Professional Organization
a) Appointment
b) Volunteer Committee Chair

AGREEMENTS:
a) I will ensure that content is not influenced by industry or financial contributors.
b) I will uphold academic standards to ensure balance, independence, objectivity, and scientific rigor.
c) I will disclose any limitations of data and/or any discussion of off-label, experimental, and/or investigational use of drugs or devices in my presentation.
d) I agree to comply with the requirements to protect health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
e) All scientific research referred to, reported, or used in accredited MAHEC activities in support or justification of a patient care recommendation, must conform to the generally accepted standards of experimental design, data collection and analysis.
f) I will allow the publication of all relevant financial and non-financial relationships in course promotional materials.
g) I will disclose all relevant financial and non-financial relationships or state that no relevant relationships exist at the start of the course.
h) I will contact Jenna Unrath (jenna@cancergenomics.org) if there are changes in relevant relationships that develop after course planning and prior to course delivery.