Manuscript Submission Cover Letter
Title of manuscript:
Name of each author:
Brief description of role of each author in development of manuscript:
Name of contact author with contact information (mailing address, phone number, email address)
Has each author completed the ICMJE
Disclosure of Conflicts of Interest
form?
Yes ____ No____
Is there any identifying information regarding a patient or other person in the manuscript?
Yes ____ No ____
If yes, provide a copy of the informed consent from the individual to use this information. The
individual must be shown the manuscript to be published. Indication of informed consent must
be included in the manuscript.
Is this manuscript reporting on research conducted on human or animal subjects?
Yes ____ No ____
If yes, have all components of Protection of Research Participants in
been followed?
Yes ____ No ____ This is not a research report manuscript ____
If applicable, indication of Institutional Review Board approval must also be included in the
manuscript.