Greater Baltimore Medical Center

Please return all forms to the address below: ______

Dear ______: We are pleased that you are willing and able to participate in our CME activity scheduled for _____ at the ______in ______.

GBMC HealthCare is accredited by the Accreditation Council for Continuing Medical Education (ACCME). As such, we have made the choice to meet the ACCME’s expectations for our practice of continuing medical education. Our accreditation is important to us. We look forward to working together to provide CME of the highest standard.

We have developed the following educational objective(s) for the program you are participating in. We expect the content of your talk will relate to this objective(s).

______

GBMC HealthCare has agreed to pay you an honoraria of ______and reimburse certain expenses you may incur as listed in our policies. It is also our policy that faculty not accept any additional payments or reimbursements from any commercial interest for presenting CME activities for GBMC HealthCare.

In addition, we would like to draw your attention to the following:

 GBMC HealthCare has provided the needs, expected results and educational objectives to the learners.

 GBMC expects that all of its CME programs will adhere to the ACCME’s content validation value statements. Specifically, all recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported or used in CME in support of justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. Please contact GBMC if you do not feel your presentation can meet these standards.

 GBMC expects that the content or format of CME activities and related materials will promote improvements or quality in healthcare and not a specific proprietary interest of commercial interest. We will disclose to learners the information you have provided us on any relevant financial relationships with commercial interest you have or the lack of these relationships prior to the activity. We also remind you that CME must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If your CME educational material or content includes trade names, trade names from several companies should be used where available, not just trade names from a single company.

 GBMC reminds that it is the responsibility of the speaker to inform participants about investigative drugs and off-label uses and we encourage you to provide this information to the audience.

 GBMC will be seeking feedback from the learners on the effectiveness of this CME activity through program evaluations.

 Educational materials that are a part of this activity, such as slides, abstracts, and handouts, cannot contain any advertising, trade names, or product-group messages.

Again, thank you for agreeing to work with us in this CME activity. Please complete the attached forms and return them to the address at the top of this letter.

Sincerely,

Laurie Wagerman Coordinator, Continuing Medical Education Speaker Information Form

Name ______Degrees ______Title ______Organization ______Address ______City ______State ______Zip ______Phone _(_____)______Fax _(____)______Email______@______

Please forward a copy of your vitae with this form!!!

AV Needs (If you have questions regarding your AV please call 443-849-3293)

__ Slide projector single image __ Slide projector double image __ Overhead projector __ Proxima for Powerpoint Presentations ** __ 16 mm projector __ External Zip Drive __ Audiocassette player __ Pointer __ Flip Chart __ 1/2” VHS VCR __ 19” color monitor __ Microphone __ 25” color monitor __ Large screen video projector

** All PowerPoint presentations must be emailed to the Conference Center at [email protected] prior to the conference!!

Travel Needs GBMC frequently utilizes the Sheraton Baltimore North Hotel (800) 433-7619. Alternative hotels are available on the GBMC website at http://www.gbmc.org/patientservices/wheretostay.cfm.

Honorarium GBMC will issues a check for your honorarium and expenses immediately upon receipt of your travel expenses. Please send expenses to the address listed on the front.

Please indicate your social security number: ______-____-______

Handouts Frequent feedback from learners confirms that handouts are essential in the learning process. Please forward any handouts you would like to have duplicated for the program to the address on the front at least 2 weeks prior to the program date.

Thank you again for your participation in this program!!!!

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