1. YOUR DISCLOSURE STATEMENT
Please read ACCME’s rule regarding standards for commercial support:
Standard 4.3: Educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, corporate logo, trade name or a product-group message of an ACCME-defined commercial interest.
Disclosure of commercial support must never include the use of a trade name or a product-group message of an ACCME-defined commercial interest. Acknowledgment of commercial support may state the name, mission, and areas of clinical involvement of an ACCME-defined commercial interest but may not include corporate logos and slogans.
Please keep this in mind when preparing your presentation
ACCME definition of a commercial interest: A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. ACCME does not consider providers of clinical service directly to patients to be a commercial interest.
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2. Select ONE of the next two slides for your presentation.
The Academy of Psychosomatic Medicine (APM) believes that maximum transparency regarding participants' affiliations and interests is in the best interest of the Academy, the annual meeting and its attendees, and the profession.
Presenters are required to disclose all forms of financial support (apart from income related to primary employment and purely clinical activities). This includes commercial involvements and other financial involvements related to the field of Psychiatry, whether or not the presenter thinks that the involvement represents a conflict of interest. APM believes the audience should determine whether there might be an apparent or potential conflict of interest, not the presenter.
Note whether any financial relationship is relevant to the presentation being planned.
APM will contact you to resolve any potential conflict of interest prior to the start of your presentation.
Select ONE of the next two slides for your presentation.
Feel free to use your own background design for the slide. Delete the red-lined boxes once you have decided which slide to use.

3. APM 2017 Disclosure: FName LName, MD
Use this slide template when financial disclosure is necessary
APM 2017 Disclosure: FName LName, MD
Company
Company A
Company B
Company C
Company D
Employment D
Management I
Independent Contractor
Consulting
Speaking & Teaching
Board, Panel or Committee Membership
D – Relationship is considered directly relevant to the presentation
I – Relationship is NOT considered directly relevant to the presentation
Note: Portions of the grid that are not needed can be grayed out. A good example might be when less than four companies are involved

4. APM 2017 Disclosure: FName LName, MD
Use this slide template if there is nothing to disclose
APM 2017 Disclosure: FName LName, MD
With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (and/or spouse/partner) and any for-profit company which could be considered a conflict of interest.