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CME Conflict of Interest Disclosure

All individuals in a position to influence the content of a certified CME activity must disclose any relevant financial relationship that might affect their independent involvement in the proposed CME activity. The intent of this policy is to ensure that any potential conflict will be identified openly so that the activity participants may form their own judgments about the presentation with the full disclosure of facts.

"Commercial interest" is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

"Relevant financial relationship" is defined as a financial benefit that you, your spouse, or an immediate member of your family has had within the past 12 months. This pertains to salaries, royalties, intellectual property rights, consulting fees, honoraria, ownership interest or other financial benefits with pharmaceutical companies, biomedical device manufacturers or other corporations whose products or services are related to the subject matter of the presentation topic.

The Kettering Health Network (KHN) Continuing Medical Education (CME) Program tries to assure balance, scientific rigor and validity in its sponsored CME events. To that end, planners and members are expected to disclose to the program any conflict of interest. This disclosure will not prevent a planner or member from participation with the CME Program.


 Presenter      Planner of KHN event(s)      Liaison for KHN event(s)      Member of KHN Advisory Group

I DO NOT have any relevant financial arrangements with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of this continuing medical education activity.

I DO have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this continuing medical education activity, as follows:

By submitting this form you attest to the accuracy of the information you have provided above and you have agreed to the Planning Committee and Speaker Guidelines.

Contacts:  Email Us

Jennifer Ianni
Jennifer Ianni
CME Coordinator
O: (937) 395-8359
F: (937) 522-8930
Martin Jacobs, MD
Martin Jacobs, MD
CME Chair
(937) 395-8611