41st Annual Echocardiography and Structural Heart Symposium Faculty Planning Form with Video Consent

*
Please list the course title.
*
Please list your name and title as they should appear on the website and other promotional materials.
*
Please enter your contact information so that we can reach you while you're traveling.

Agreement

A. Unbiased and Independent Content

I agree to uphold academic standards to insure independence and scientific rigor in my role in the development and presentation of this CME & CE activity.

*
B. Presentation Guidelines: 

Instead of providing a syllabus, Baptist Health CME provides registered attendees with access to speakers’ presentations in PDF format on a limited access webpage before and after the symposium. Access will be shared only with symposium attendees and faculty and will be available until two weeks after the symposium. 

*
*
NOTE: We cannot post presentations which are not compliant with laws related to copyright/fair use, HIPAA or PHI.
C. HIPAA & PHI (Protected Health Information) Laws

It is the responsibility of the faculty to comply with HIPAA laws, and they are liable in case of any privacy breach that violates HIPAA regulations. Faculty members are expected to remove all identifying information from presentation materials. If presentations require the use of patient images for effective teaching, presenters must obtain patient consent as required by HIPAA.

*
*
E. Unlabeled / Unapproved Use

Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning. 

I agree to disclose to the audience if my e-Poster includes information about a product not labeled by the FDA for the use under discussion or that is still investigational.

*
Select one.
*

Attestation

*
Please sign your name.
*

Need to contact us?

Baptist Health CME
8940 North Kendall Drive
Suite 702E
Miami, FL 33176

Phone: 786-596-2398
Fax: 786-533-9821
Email: CME12@BaptistHealth.net