Faculty Name: * CME Activity: Activity Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027 Your role in this CME: * Check all that apply Presenter Content Reviewer Course Director Moderator Planning Committee Attestation Statements * I agree to the following regarding my participation in this CME activity: I attest that I will present balanced, evidence-based, and unbiased therapeutic options and will not favor, promote, or market any products, devices, drugs, or services from the ineligible company with which I have a financial relationship or any other ineligible company. I attest that all clinical statements, case discussions, and recommendations will be based on current, evidence based, peer reviewed literature. I attest that all scientific research referred to, reported, or used in CME in support of justification of a patient care recommendation will conform to the generally accepted standards of experimental design, data collection, and analysis. I attest that I will use generic names for medications/devices to the extent possible. If I need to use trade names, those from several companies will be used when available, and not just trade names from any single company. I attest that I will not use slides, graphics, logos, data, or materials created by or funded by an ineligible company. I attest that if I discuss unlabeled or investigational uses, I will clearly identify them and provide supporting evidence. I attest that I will not accept honorarium, travel expenses, in-kind contributions, or any other support from any ineligible company in connection with this activity. I attest that I will comply with all HealthPartners CME mitigation requirements, including potential review of course content and presentation monitoring by the CME office, course chair, moderator, and/or course coordinator. Leave this field blank
