Conflict of Interest Form

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CPD Providers:

The CFPC requires all presenters and members of Planning Committees to complete the CFPC Mainpro+® Declaration of Conflict of Interest form as part of the Mainpro+ certification process.

A conflict of interest might be present in situations where the personal and professional interests of individuals have actual, potential, or apparent influence over their judgment and actions.

What kind of relationships should be disclosed?

Please note that potential conflicts are not limited to the following examples.

  • Any direct financial interest in a for-profit entity such as a pharmaceutical organization, medical devices company, communications firm, or other financial supporter of the program (“the Organization”)
  • Investments held in the Organization
  • Membership on the Organization’s advisory board or similar committee
  • Current or recent participation in a clinical trial sponsored by the Organization
  • Membership with a speakers bureau
  • Holding of a patent for a product referred to in the CPD activity or marketed by a commercial organization
  • Receiving honoraria to speak on behalf of a pharmaceutical organization or medical communication company, including talks for which the individual has been contracted but has not yet received payment for
  • Financial relationships with program-sponsoring organizations that are non-pharmaceutical or non–health care organizations (eg, insurance companies, financial institutions, government, for-profit organizations, other non-profit organizations)

Failure to disclose or false disclosure might require the Planning Committee to replace the presenter/speaker.

Planning Committee: A completed form for each planning committee member must be submitted at the time of application for certification. Please scan and upload all forms as a single file on CERT+.

Presenter: These forms must be submitted if speakers are known at time of application for certification. If speakers/presenters are not yet known, the forms do not need to be submitted to the CFPC at the time of application for certification. Completed forms for each presenter or speaker must be submitted at ethical review and copies of all speaker/presenter CoI forms must be retained by the CPD provider.

Download the Declaration of Conflict of Interest form.

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