HGF PRESENTER & MODERATOR

CME FORM

INSTRUCTIONS: Enter the information requested below

Ineligible Companies:

Please note that ineligible companies are not eligible for accreditation.

ACCME has incorporated eligibility information directly into the Standards for Integrity and Independence in Accredited Continuing Education. Companies that are ineligible to be accredited in the ACCME System (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

Standard 2: Prevent Commercial Bias and Marketing in Accredited Continuing Education

Standard 2 applies to all accredited continuing education. Accredited continuing education must protect learners from commercial bias and marketing.

1. The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.

2. Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.

3. The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.

As an ACCME-accredited CME provider, the Tennessee Medical Association (TMA) only certifies activities for AMA PRA Category 1 Credit™ in which the content is based on:

• the educational needs of physicians,

• rigorous scientific evidence from research or the clinical experience of experts, and

• development that is independent of commercial influence.

ACCME guidelines require that anyone who is in a position to develop or contribute to the development of CME content disclose to participants any relevant financial relationships with ineligible companies - entities that produce, market, re-sell, or distribute healthcare goods or services used by patients.

If financial relationships exist, the individual must ensure that the content they contribute remains evidence-based, addresses identified educational needs, and is free of commercial bias.

ACCME standards also stipulate that any individual who does not provide the requested disclosure information prior to assuming their role in a CME activity must not participate in the activity.

LEARNING OBJECTIVES (Does not Apply to Moderators)

Please provide your action-oriented objectives for your presentation. Describe changes to skills and abilities (competence), the medical practice (performance), & patient outcomes rather than just changes to knowledge.

Finish this sentence for each criterion:

As a result of my presentation, learners should be able to:

ATTESTATIONS:

Please read the following attestations.

By signing you agree to abide by the policies and regulations addressed in this form.

• I will ensure that the content for this activity, including any presentation of therapeutic options, will include recommendations for patient care based on current science, evidence, and clinical reasoning while giving a fair and balanced view of diagnostic and therapeutic options. 

• I will ensure that all scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, analysis, and interpretation. 

• I will ensure that new and evolving topics in CME are clearly identified as such within the presentation(s) without advocating for or promoting, practices that are not or not yet adequately based on current science, evidence, and clinical reasoning. 

• I will not advocate for unscientific approaches to diagnosis or therapy, nor manners of practicing healthcare that is determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients. 

• I will ensure that the presentation of the information will promote quality or improvements in healthcare and will not promote a specific proprietary business interest or ineligible company. 

• The accredited education I provide will serve to maintain, develop, or increase the knowledge, skills & professional performance & relationships that a physician uses to provide services for patients, the public or the profession. 

• The education I provide will be fair and balanced and any clinical content supports safe and effective patient care. 

• The accredited education I provide in my educational materials (slides, abstracts, handouts, etc.) will be free of marketing or sales of all products/services including logos, trade names, or product group messages, and I will not actively promote or sell products/services that serve my professional interests. 

• I verify that prior to the presentation; I have requested and/or obtained permission from copyright holder(s) to reproduce/copy, from their work, the portions of my presentation that are protected by copyright laws. I acknowledge that the Human Growth Foundation will not be held legally responsible for any misrepresentation on my part regarding copyright infringement. 

• If presenting specific patient cases or case histories, I attest that I have HIPAA-compliant authorization for any PHI (Protected Health Information) in the presentation materials or have de-identified all materials to the extent possible in adherence to my organizational and state laws. Educational activities happening off-campus (UTMC) must be completely deidentified. 

  
  

  1. acknowledge that the Human Growth Foundation or its designees may request to review my presentation and/or content prior to the activity, and I will provide educational content and resources in advance following all deadlines as requested. 

  2. acknowledge that the Office of CME may have someone attend or monitor the activity to ensure that the presentations, 

     educational materials, and activity are educational, not promotional in nature. 

  3. hereby consent to the duplication of my presentation and to its inclusion in the course handouts and in any enduring materials 

     maintained in connection with the course in any format or media whatsoever. 

  4. acknowledge that continuing education accreditation guidelines prohibit me from accepting any reimbursement (honoraria, additional pay, reimbursements, financial gifts, or in-kind exchange) for this presentation from any source other than the Human Growth Foundation or the organization for which I am presenting. 

• My disclosure provided above is accurate for the past 24 months. 

• My financial relationships will not influence or bias the education at this activity. 

• I will contact the HGF Office of CME if there are any changes to my financial relationships prior to the start of the activity. 

• By typing or signing my name below, I attest that the above information is accurate and complete, and I agree to comply.