Conflict of Interest Disclosure Form

As a CME provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), Lighthouse Guild must ensure balance, independence, objectivity, and scientific rigor in all its directly or jointly provided educational activities.  As such, Lighthouse Guild requires all individuals in a position to control the content of an educational activity (including the individual’s spouse/domestic partner) to provide a signed disclosure form to Lighthouse Guild prior to the initiation of the activity.  In order to ensure its CME activities promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest, Lighthouse Guild will identify and resolve all conflicts of interest prior to the delivery of the activity to the learner.  Based on this disclosure information, Lighthouse Guild may disqualify any individual from planning and implementation if a conflict of interest that may contribute to commercial bias is determined to exist and cannot be resolved. 

Instructions: Individuals are required to disclose all relevant financial relationships in any amount with commercial interests within the past 12 months as well as the nature of the relationship. The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.    

In accordance with the Standards of Commercial Support set forth by ACCME, the undersigned understands and accepts the policies and standards as set forth in this document.

Individuals who do not provide the requested disclosure information will be disqualified from participating in the development and delivery of a CME activity.

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