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Financial and Other Disclosures

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Presentation on theme: "Financial and Other Disclosures"— Presentation transcript:

1 Financial and Other Disclosures
Off-label use of drugs, devices, or other agents: None or FILL IN HERE; including your local regulatory agency, such as FDA, EMA, etc. Data from IRB-approved human research is presented [or state: “is not”] I have the following financial interests or relationships to disclose: Disclosure code* Company name C E L O P S * Consultant (C) Employee (E) Lecture fees (L) Equity owner (O) Patents (P) Grant support (S) Consultant (C) Consultant fee, paid advisory boards Advisor fees for attending a meeting (for the past 1 year) Employee (E) Employed by a commercial entity Lecture fees (L) Lecture fees (honoraria), travel fees or reimbursements when Speaking at the invitation of a commercial entity (for the past 1 year) Equity owner (O) Equity ownership/stock options or publicly or privately traded firms (excluding mutual funds) with manufacturers of commercial ophthalmic products or providers of commercial ophthalmic services Patents (P) Patents and/or royalties that might be viewed as creating a Royalty potential conflict of interest Grant support (S) Grant support for the past 1 year (all sources) and all sources used for this project if this form is an update for a specific talk or publication with no time limitation

2 Financial and Other Disclosures
Off-label use of drugs, devices, or other agents: None or FILL IN HERE; including your local regulatory agency, such as FDA, EMA, etc. Data from IRB-approved human research is presented [or state: “is not”] I have the following financial interests or relationships to disclose: Disclosure code No financial relationships N


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