Education
ASAM CME Education Disclosure of Relevant Financial Relationships Form
ASAM CE Education Disclosure of Financial Relationships Form
ASAM, as a Jointly Accredited provider, must ensure that this activity and its contents are in full compliance with guidelines prescribed by Joint Accreditation for Interprofessional Continuing Education and the Standards for Integrity and Independence in Accredited Continuing Education (ACE).
All individuals in a position to affect content (including planners, content developers, and presenters) must complete the following financial disclosure form prior to the planning, development, or presentation of an educational activity to ensure adequate review time by the ASAM CE Committee. Please click here to view a letter from the ASAM CE Committee.
Glossary of Terms
Ineligible Companies
As defined by ACCME, Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples of such organizations include:
- Advertising, marketing, or communication firms whose clients are ineligible companies
- Bio-medical startups that have begun a governmental regulatory approval process
- Compounding pharmacies that manufacture proprietary compounds
- Device manufacturers or distributors
- Diagnostic labs that sell proprietary products
- Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
- Manufacturers of health-related wearable products
- Pharmaceutical companies or distributors
- Pharmacy benefit managers
- Reagent manufacturers or sellers
The ACCME does not consider providers of clinical service directly to patients to be an ineligible company.
Financial Relationships
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.
Clinical Condition
This is the disease state, clinical condition, or clinical area that a financial relationship relates to or impacts.
Instructions
- List the names of all ineligible companies with which you have had or do have a financial relationship within the past 24 months.
- Describe what you received (ex: salary, honorarium etc).
- Describe your role.
- Describe the clinical condition or clinical area that this financial relationship was in (eg, addiction medicine, psychiatry, dermatology).