2025 SPP Financial Relationships Disclosure Form

Accredited CE Activities: Individuals in Control of Content Financial Relationship Disclosure Form

The Society for Pediatric Pathology (SPP)
Name of Individual*

First NameLast Name
Credentials, if applicable (e.g., MD, PhD, etc.)
Affiliation:*
Purpose: The information you provide addresses requirements of the Accreditation Council for Continuing Medical Education (ACCME) to help ensure integrity and independence in accredited Continuing Education (CE) activities. Everyone in a position to control the content of an accredited CE activity must disclose all financial relationships with ineligible companies, within the past 24 months (whether the relationship has now ended or is currently active) to the Society for Pediatric Pathology. The Standards for Integrity and Independence in Accredited CE require that the Society for Pediatric Pathology disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited CE. The Society for Pediatric Pathology must mitigate relevant financial relationships and disclose these relevant financial relationships to participants prior to the beginning of the activity.

Definition: An ineligible company is any entity whose primary business is producing marketing, selling, re-selling, or distributing healthcare products used by or on patients. For a list of examples, click the link.

Instructions: Please disclose all financial relationships (any amount) that you have had in the past 24 months with ineligible companies. You should disclose all financial relationships regardless of the potential relevance of each relationship to the education.

Please note: If you are an employee, owner, co-owner, founder, or co-founder of an ACCME-defined ineligible company (any entity whose primary business is producing marketing, selling, re-selling, or distributing healthcare products used by or on patients) please select "Yes" and enter the corresponding information on the page that follows. The use of employees of ACCME-defined ineligible companies as faculty and planners or in other roles where they are in a position to control the content of accredited CE is prohibited, except in specific situations. In order to ensure accredited CE compliance, the SPP must carefully review situations in which an individual is an employee, owner, co-owner, founder, or co-founder.
Disclosure: Regarding my role in accredited CE activities (selected one):*

No, I have no personal financial relationship(s) with ineligible companies.Yes, I have personal financial relationship(s) with ineligible companies (Provide information on the next page.)

Please use this page to disclose all financial relationships with ineligible companies to the Society for Pediatric Pathology.
Nature of Financial Relationship: Employee
Name of Ineligible Company/Companies (Employee):
Nature of Financial Relationship: Owner/Co-Owner/Founder/Co-Founder
Name of Ineligible Company/Companies (Owner/Co-Owner/Founder/Co-Founder):
Nature of Financial Relationship: Consulting Fee (e.g., Advisory Board)
Name of Ineligible Company/Companies (Consulting Fee):
Nature of Financial Relationship: Contracted Research (PIs must provide information, even if received by the institution)
Name of Ineligible Company/Companies (Contracted Research):
Nature of Financial Relationship: Honoraria
Name of Ineligible Company/Companies (Honoraria):
Nature of Financial Relationship: Speaker's Bureau
Name of Ineligible Company/Companies (Speaker's Bureau):
Nature of Financial Relationship: Stock Shareholder (Individual stocks; diversified mutual funds do not need to be disclosed)
Name of Ineligible Company/Companies (Stock Shareholder):
Nature of Financial Relationship: Stock Options Holder
Name of Ineligible Company/Companies (Stock Options Holder):
Nature of Financial Relationship: Royalty
Name of Ineligible Company/Companies (Royalty):
Nature of Financial Relationship: Other – Describe (e.g., patent holder/receipt of intellectual property rights, etc.):
Name of Ineligible Company/Companies (Other):
Have any of the above relationships ended?*

YesNo
If a financial relationship existed during the last 24 months, but has now ended, please indicate this below:

Mitigating Relevant Financial Relationships: Should the Society for Pediatric Pathology determine that a disclosed financial relationship(s) is relevant, the Society for Pediatric Pathology will begin a series of steps to mitigate the relevant financial relationship(s) based on the individual’s role in the activity and identify what, if any, action is necessary. The mitigation mechanism will identify potential bias and ensure content is aligned with interests of the learner. Only when the relevant financial relationship(s) has been mitigated may the individual participate in the activity.
Validation Statements: The Society for Pediatric Pathology supports the validation of clinical content for all accredited CE activities. Please review the following statements and indicate your intent to comply with each expectation by checking the box. If you have any questions, please contact the Society for Pediatric Pathology at info@spponline.org.
Statement 1*

All recommendations for patient care in the activity, must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
Statement 2*

All scientific research referred to, reported, or used in the activity, in support or justification of patient care recommendation, must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
Statement 3*

The content will NOT advocate for unscientific approaches to diagnosis or therapy, nor promote recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.
Signature & Attestation: I attest this annual disclosure is correct and complete and will provide any updates/changes to the status of this information should it change.
By typing your name here, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your written signature on this form.
Signature:*
Date:*

MonthDayYear
E-mail*
Phone Number*

Area CodePhone Number
Thank you for taking time to complete this form. If you have any questions, please contact Rachael Lowery, Society for Pediatric Pathology at info@spponline.org.
Should be Empty:

Accredited CE Activities: Individuals in Control of Content Financial Relationship Disclosure Form

Please use this page to disclose all financial relationships with ineligible companies to the Society for Pediatric Pathology.