Faculty Planning with Disclosures  with Video Consent

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Baptist Health, through its nationally accredited Continuing Medical Education Program, maintains compliance with the ACCME’s Policy on CME Clinical Content Validation and the Standards for Integrity and Independence. Additionally, we are responsible for compliance with laws related to copyright/fair use, HIPAA and Protected Health Information. To that end, we are obliged to resolve any conflicts of interest and to review course content prior to the educational course. Therefore, we request your timely response to our requests for information. As faculty for this series, you agree to the following learning objectives based on identified practice gaps and planning timelines to ensure compliance with Accreditation Council for Continuing Medical Education criteria.

Content Review: CME Providers are responsible to conduct reviews of educational presentations and materials before the activity is delivered to the learner. Your presentation should be submitted to AlexandrSa@baptisthealth.net no later than 72 hours prior to your lecture date.

Learning Objectives:

  • Implement evidence-based strategies into clinical practice that will improve delivery of care to patients treated at South Miami Hospital.
  • Apply procedures and practices according to national guidelines.

Your acceptance of this invitation is contingent on the stipulation that you agree that you will not accept any payment related to your participation in this CME activity. To confirm your agreement with your role and responsibilities as a speaker, please sign and date.

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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.

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B. Presentation Guidelines: 

For compliance with ACCME requirements your presentation will need to include the following slides:

Disclosure of Financial Relationships      
Learning Objectives, 
Summary: Key Learning Points with References  
Citations and References (evidence-based, peer-reviewed)

Baptist Health CME provides registered attendees with access to speakers’ presentations in PDF format via email to registered attendees only.  

C. HIPAA & PHI (Protected Health Information) Laws

I take responsibility for compliance with HIPAA Privacy requirements and applicable state and United States federal laws protecting confidentiality and security of PHI and safeguarding PHI.

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D. Copyright/Fair Use Laws
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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 presentation includes information about a product not labeled by the FDA for the use under discussion or that is still investigational.

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F. Baptist Health CME Portal Learning Management System Consent to Video

I, the undersigned, do hereby voluntarily participate and give authorization for myself to appear in filming, photographs, videotaping, audiotaping and/or interviews for medical, clinical, and hospital education and training.  I do hereby consent to the specific use of such production, which includes my name, likeness, and the content I present, for continuing medical education.

I do hereby release Baptist Health South Florida, its agents, and its employees from all liability in connection with the above-referenced educational content. I waive any right to inspect or approve the finished product or the advertising or other copy that may be used in connection with the educational content produced. I hereby consent to the use of such content for continuing medical education, without expectation of remuneration to me now or in the future, and this shall be binding upon my heirs, personal representatives and assigns.

Specific Use: The video and/or audio recording will be used strictly for non-profit educational purposes of the Baptist Health South Florida Continuing Medical Education Department described above. It will not be sold to a third party, individually or in combination with other presentations, as an educational tool now or anytime in the future.
 

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Disclosures

Baptist Health South Florida, an ACCME accredited CME provider, operates within the framework of the Standards for Integrity and Independence in Accredited Continuing Education to insure balance, independence, objectivity and scientific rigor in all of its CME activities. Anyone engaged in content development, planning, review or presentation is obliged to complete this form. The ACCME Standards for Integrity and Independence require that we disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited continuing education.

  1. Circumstances create a conflict of interest when an individual has an opportunity to influence or control CME content about products or services of an ineligible company with which he/she has a financial relationship.
  2. The ACCME defines an “ineligible company” as any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
  3. ACCME requires that faculty disclose all financial relationships that you have had in the past 24 months with ineligible companies.

For each financial relationship, enter the name of the ineligible company and the nature of the financial relationship(s).
There is no minimum financial threshold; we ask that you disclose all financial relationships, regardless of the amount, with ineligible companies. You should disclose all financial relationships regardless of the potential relevance of each relationship to the education.
NOTICE: Please do not disclose actual financial value of affiliations. Diversified mutual funds are not included in the definition of "commercial interest".

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NOTE: Please do not disclose actual financial value of affiliations. Diversified mutual funds are not included in the definition of "commercial interest."
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Attestation

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Please sign your name.
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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