Pursuant to the Code of Ethics for the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Standards for Commercial Support of Continuing Medical Education of the Accreditation Council for Continuing Medical Education, the AAAAI requires disclosure of financial relationships from all staff members whose jobs may provide the opportunity to influence the content of AAAAI educational activities.

Disclosure by staff will be made in writing through use of the Staff Disclosure Form. A completed form is to be returned to the Director of Education at the time of employment and annually thereafter. Disclosure must be updated whenever circumstances require or once per calendar year, whichever is sooner.

Staff Disclosure Forms will be compiled by the Director of Education and, if financial relationships are disclosed, reviewed by the EDI Chief Operating Officer (COO).  Any necessary determination of conflict of interest will be made and addressed by the COO and the Director of Education.  Following review, Staff Disclosure Forms will be maintained in a sealed envelope and locked in the EDI Human Resources Department.  Forms and information contained in them will be maintained with the utmost confidentiality.

Please review the AAAAI Disclosure Policy (attached) for additional information about the AAAAI's management of financial relationships and conflict of interest.

Definitions
For purposes of the Staff Disclosure Form, Conflict of Interest is defined as having a financial relationship with a commercial interest and the ability to affect content of AAAAI educational activities about the products or services of the commercial interest.  A commercial interest is defined by the ACCME as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.”  Note:  Mutual funds, IRAs etc. are excluded from the disclosure requirement.

Instructions
Complete the questions below. If you indicate that you have financial relationships with ACCME-defined commercial interests you will be contacted to provide additional details about these relationships, and this information will then be reviewed. If you indicate that you have no financial relationships with ACCME-defined commercial interests then no further action will be required.

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Are you employed with any other allergy-related organization?
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If you answered "Yes" above, provide the name of other allergy organizations with which you work.
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If you work with another allergy-related organization, provide your job title for that role.

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.” 

Examples of financial relationships you may have with these types of organizations include stock ownership, serving as a consultant or on an advisory board, or employment. You should disclose any relationships involving you personally, or relationships of your spouse or significant other. Be aware that investment in an ACCME-defined commercial interest through a 401(k) or 403(b) retirement account, Individual Retirement Account (IRA), or mutual fund is not considered a direct financial relationship with the commercial interest and is not subject to these disclosure requirements.

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Do you have any financial relationships with ACCME-defined commercial interests?

If you indicated that you have no financial relationships with ACCME-defined commercial interests then no further action is needed as you have nothing to disclose.

If you indicated that you have a financial relationship with an ACCME-defined commercial interest, you will be contacted to collect additional details about these relationships. These relationships will be reviewed to determine whether or not they present a conflict of interest, and if so what actions are needed to resolve them.

Thank you for completing this form. If you have questions about the conflict of interest process please contact Steve Folstein, Director of Education, at sfolstein@aaaai.org.