As noted on the COI form and COI Guidelines, owners, employees, and those holding private stock of ineligible companies must be excluded from planning or implementation of the education (or qualify for an exception).

 

This form needs to be completed by the individual who has disclosed a relationship as an 'owner', 'employee', or 'private stockholder' of an ineligible company. Submissions on behalf of other individuals will not be accepted.

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Please enter the name of the Speaker/Planning Committee member who has disclosed they hold private stock, are an employee or owner of an ineligible company.
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Reminder: If more than one company is listed on the COI as private stock, owner, or employee, submit a separate form for each company.

Step One:

Please review the COI Disclosure and confirm that the form is accurately depicting relationships with an 'ineligible company'.  Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Note:  biomedical startups that have not begun a governmental regulatory approval process are NOT considered an ineligible company and therefore do not need to be disclosed. 

  • Common examples: Pharmaceutical companies or distributors, Device manufacturers or distributors, Manufacturers of health-related wearable products.
  • Examples that do NOT need disclosed: Software or game developers, Government or military agencies, Health profession membership organizations, and biomedical startups that have not begun a governmental regulatory approval process.

Proceed with the form below and confirm whether the listed company meets the above definition of ineligible company. If more than one company is listed, submit a separate worksheet for each company.

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Please review the definition and description of an Ineligible Company above prior to answering this question.

If this relationship does not pertain to an ineligible company, it does not need to be disclosed and is incorrectly included on the form. Please complete and upload a corrected COI Disclosure Form below and submit this worksheet.

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Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

If needed, choose 'save draft' now to save and exit the form. Your current entry will populate after reopening the Private Stock/Owner Mitigation Worksheet 

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Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Step Two:

Please review the COI Disclosure and confirm that the form is accurately depicting 'private stock', 'ownership', or 'employment' with an ineligible company. It is common for presenters to list “private stock” in error.

  • “Stock options” and "mutual funds" are not private stock.
  • Be sure any publicly traded stock is not incorrectly entered as privately held stock. 

Proceed with the form below. 

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If this relationship does not pertain to private stock, ownership, or employment of an ineligible company, it does not need to be disclosed and is incorrectly included on the form. Please complete and upload a corrected COI Disclosure Form below and submit this worksheet.

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Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

If needed, choose 'save draft' now to save and exit the form. Your current entry will populate after reopening the Private Stock/Owner Mitigation Worksheet 

Step Three:

Is content of the activity related to the business lines of the company, regardless of whether the company is mentioned in the presentation?

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Please provide written justification to support that the topic of the presentation is not related to the business lines of the company. If you cannot provide justification, you will not be eligible to participate in the presentation.

If needed, choose 'save draft' now to save and exit the form. Your current entry will populate after reopening the Private Stock/Owner Worksheet. When ready, please submit the Private Stock/Owner Worksheet 

If needed, choose 'save draft' now to save and exit the form. Your current entry will populate after reopening the Private Stock/Owner Worksheet. When ready, please submit the Private Stock/Owner Worksheet