First, indicate in the Declaration Statement whether or not you (or your spouse/partner) have had any financial interest or relationships with commercial interests within the past 12 months.
Second, if you (or your spouse/partner) have financial interests, describe them under either:
A) Grant and Research Support,
B) Employment, or
C) Other types of relationships.
Give the names of relevant commercial entities. A drop-down list of some company names is provided. If the particular company does not appear on this list, please enter the name in the space provided. Relationships with non-commercial entities such as universities, hospitals, government agencies, foundations and non-profit societies are not to be included.
For “Other types”, provide a description of the relationship, what was received, and the name of the company. Drop-down lists are provided. If your particular entry does not appear on these lists, please describe it in the spaces provided. The ISMRM does NOT want to know how much you received. Please do not provide the amount.
Note: If you have more than one of a type of financial interest or relationship to disclose, please complete this form separately for each disclosure.
A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The Accreditation Council for Continuing Medical education (ACCME) does not consider providers of clinical service directly to patients to be commercial interests.