UNC-Chapel Hill Digital and Lifelong Learning Accreditation Form

Page 1


Learning Objectives
Please create 3 or more learning objectives for your presentation. Objectives should begin with one of these verbs:
arrange, calculate, choose, compare, create, define, demonstrate, describe, differentiate, discuss, distinguish, explain, identify, implement, improve, label, list, locate, measure, modify, organize, perform, rate, recall, recognize, select, use
At the end of this lecture, the participant will be able to:

Part II must by completed ONLY if a financial relationship with an ineligible company has been reported above.

Page 2

Financial Relationship: Any relationship which benefits you financially.


Financial relationships include grants where the money goes to your organization, if you are the Principal Investigator. Financial relationships must be reported even if they have ended; in such cases, the end date should be noted in the Disclosure Grid.


Ineligible Company: Companies that are ineligible to be accredited in the ACCME System are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Ex: pharmaceutical companies, device manufacturers.


Eligible organizations include hospitals, physician practices, diagnostic labs that do not sell proprietary products, education companies (such as Elsevier or UpToDate), insurance companies, software companies (including electronic medical record companies), and government agencies. If you are uncertain about the eligibility of an organization, list it on the Disclosure Grid.

Disclosure of Relevant Financial Relationships

*Employees and people with ownership interests are prohibited from any involvement in planning CME events.  The ACCME also strictly limits their involvement as presenters.  If either of these applies, please be sure to submit your COI form with as much advance notice as possible so UNC Continuing Professional Development (CPD) can 
mitigate the potential effect of these relationships and verify whether your talk is eligible for credit. 

**Financial relationships that were active in the past 24 months but which have since ended must be disclosed, and the end date must be listed.

Page 3

I have carefully read and considered each item in this form and have completed it to the best of my ability.