Conflict Of Interest Disclosure Page 4
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4ATTESTATION OF AUThORShIP
Instructions:
1. Part I of this form MUST be completed by all authors.
2. Part II of this form MUST be completed by the corresponding author.
3. Forms from all authors must be received by JDSM’s editorial office before a manuscript will be considered for
publication by JDSM’s editorial staff.
4. All authors must sign.
Part I: Attestation of Authorship Contribution (to be completed by all authors)
As an author of the manuscript entitled:
I attest to having provided substantive intellectual contribution to one or more of the following activities related to this
manuscript (one or more boxes MUST be checked).
Study design
Data collection
Data analysis
Interpretation of results
Preparation of the manuscript
Individuals not performing one of the above activities do not meet JDSM’s authorship criteria.
Part II: Attestation of Writing Assistance (to be completed by all corresponding authors)
Has anyone other than the authors assisted in writing the text or conducting statistical analyses of the data?
Yes
No
If Yes:
Provide the name(s) of those who assisted in the writing:
Indicate who provided the funding for the writing assistance or data analysis:
Individuals indentified in Part II should be added as authors or listed in the manuscript’s acknowledgments.
By signing below, I certify that I have read and approved the manuscript draft submitted for publication, and I certify to
the best of my knowledge that the information provided on this form is true and accurate.
________________________________________________________________________________
Name (print)
____________________________________________________________
__________________
Signature*
Date
* Note oN electroNic sigNatures: Signature fields can be left blank if you do not have an electronic signature. However, you will need to print
out the form, sign it, fax a copy to Rosanne Money at (630) 737-9790, or scan and email to .
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