Please enter the information below concerning the presenting author(s) of the abstract. The presenting author must submit all required contact information and complete the section on disclosure of financial relationships.  The Accreditation Council for Continuing Medical Education requires that CME providers identify and resolve any potential conflict of interest related to educational content. Abstract submissions will not be considered if disclosure is not provided.

By submitting an abstract, you are agreeing that if it is accepted, you will attend and display a poster as described in your accepted abstract. Presenting authors are required to pay the conference registration fee and all associated travel expenses to attend the conference.

Penn State College of Medicine is committed to presenting CME activities that promote improvements or quality in health care and are developed free of the control of ineligible companies (formerly known as a commercial interest). It is our policy to ensure that our activities are balanced, independent, objective, scientific, and in compliance with regulatory requirements. Anyone who is in a position to control the content of a CME presentation (course directors, faculty, planning committees, etc.) is expected to disclose all financial relationships with ineligible companies. The information listed on this form will be used to assess and mitigate any potential conflict of interest you may have, and will be disclosed to the audience of the CME activity. Faculty/planners who refuse to disclose will be disqualified from participating in this CME activity.

Please disclose all financial relationships that you have had in the past 24 months with ineligible companies (see definition below). 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.

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. The ACCME does not consider providers of clinical services directly to patients to be an ineligible company.

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.

By submitting this form, I am providing my electronic signature approving all of the information submitted.