1. YOUR DISCLOSURE STATEMENT Of particular note this year is a rule change by ACCME regarding standards for commercial support, specifically: 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. For full details, please visit: http://www.accme.org/requirements/accreditation-requirements- cme-providers/policies-and-definitions/definition-commercial-interesthttp://www.accme.org/requirements/accreditation-requirements- cme-providers/policies-and-definitions/definition-commercial-interest

2. 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. Per APM Policy and in keeping with ACCME Guidelines, APM authors and speakers are expected to: Disclose to APM and meeting attendees the existence of any financial relationships with any for-profit companies that are directly or indirectly related to the subject of their presentation (or the lack of such relationships) within the past 24 months through disclosure forms and session materials. Note whether any of the financial relationships are relevant to the presentation being planned. Work with APM to ensure that any conflicts of interest are resolved prior to the start of the presentation.

3. APM 2014 Disclosure: FName LName, MD CompanyCompany ACompany BCompany CCompany D EmploymentD Management I Independent Contractor Consulting Speaking & Teaching D Board, Panel or Committee Membership I 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 D – Relationship is considered directly relevant to the presentation I – Relationship is NOT considered directly relevant to the presentation Use this slide template when financial disclosure is necessary

4. APM 2014 Disclosure: FName LName, MD Use this slide template if there is nothing to disclose 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 in the past 24 months which could be considered a conflict of interest.