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Get the free Conflict of Interest Statement with Financial Disclosure Form - uphs upenn

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Disclosure of Relevant Financial Relationships, Center for Evidence-based Practice (CEP) Name: Topic of CEP Review: Date of First Review Meeting: Please review the Example Terminology on page 2 before
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A conflict of interest statement is a document that discloses any potential conflicts of interest that an individual may have in a particular situation, such as when serving on a board or committee.
The individuals who are required to file a conflict of interest statement are usually those who hold positions of authority or influence, such as board members, committee members, or employees in certain organizations.
To fill out a conflict of interest statement, the individual should provide their personal information, such as name and contact details, and disclose any potential conflicts of interest they may have. This may include financial interests, relationships, or other factors that could influence their decision-making.
The purpose of a conflict of interest statement is to promote transparency and integrity in decision-making processes. By disclosing potential conflicts of interest, individuals can help ensure that their actions and decisions are not influenced by personal gain or bias.
The information that must be reported on a conflict of interest statement depends on the requirements of the organization. However, common information includes financial interests, relationships with other individuals or organizations, and any other factors that may create a conflict of interest.
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