1. , when conflicts of interest to disclose exist
Form 1
A sample slide for an oral or poster presentation to disclose COI status
, when conflicts of interest to disclose exist
Japanese Society for Adult Congenital Heart Disease COI Disclosure 　 Name of First Author : ○○　○○ all names of co-authors: △△　△△、 □□　□
If “yes”, leave the relevant item (s) and give the name (s) of company/organization. There is no need to disclose the amount.
Trust research/joint research funds:　　　○○pharmaceutical company
　　Scholarship fund:　○○pharmaceutical company
　　Affiliation with Endowed Department:　　yes（○○pharmaceuticals）