Bio-Conflict-Of-Interest-Form - Baromedical Nurses Association (Page 3 of 4) in pdf



Evidence of a relevant relationship with a commercial interest may include but is not limited to

receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership

interest (stock and stock options, excluding diversified mutual funds), grants, contracts, or other

financial benefit directly or indirectly from the commercial interest.



Financial benefits may be associated with employment, management positions, independent

contractor relationships, other contractual relationships, consulting, speaking, teaching,

membership on an advisory committee or review panel, board membership, and other activities

from which remuneration is received or expected from the commercial interest.

Is there an actual, potential or perceived conflict of interest for yourself or spouse/partner?

Yes

___ No

If yes, complete the table below for all actual, potential or perceived conflicts of interest**:

Check all that

Category

Description

apply

Salary

Royalty

Stock

Speakers Bureau

Consultant

Other

** All conflicts of interest, including potential ones, must be resolved prior to the planning,

implementation, or evaluation of the continuing nursing education activity.

Section 5: Conflict Resolution

(to be completed by Nurse Planner)

A. Procedures used to resolve conflict of interest or potential bias if applicable for this activity:

(Check all that apply)

____ Not applicable since no conflict of interest

Removed individual, with conflict of interest, from participating in all parts of the educational activity.

Revised the role of the individual with conflict of interest so that the relationship is no longer relevant to

the educational activity.

Not awarding contact hours for a portion or all of the educational activity.

Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,

balance in presentation, evidence-based content or other indicators of integrity, and absence of bias,

AND monitoring the educational activity to evaluate for commercial bias in the presentation.

Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,

balance in presentation, evidence-based content or other indicators of integrity, and absence of bias,

AND reviewing participant feedback to evaluate for commercial bias in the activity.

Other - Describe:

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