If you answer yes, you will be required to (1) List the names of all commercial interests (defined in the “Glossary of Terms” on the previous page) with which you or your spouse/partner have, or have had, a relevant financial relationship within the past 12 months. For this purpose we consider the relevant financial relationships of your spouse or partner that you are aware of to be yours. (2) Describe what you or your spouse/partner received (ex: salary, consultant fee, research grant, honorarium, stock, etc). International Institute of Continuing Medical Education (iiCME) does NOT want to know how much you received. (3) Describe your role. (4) If no relationship exists, this information must be disclosed as well.
Commercial Interest:
ABC Company
What was received?
Salary, Royalty, Intellectual Property Rights, Consulting Fee, Honoraria, Ownership Interest, etc.
For What Role?
Employment, Independent Contractor, Consulting, Speaking and Teaching, Membership on Advisory Committees or Review Panels, etc.