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Forms, Documents, and Requirements

General forms for single conference, jointly sponsored conference, and RSS
Forms for RSS only


Application

To receive a current application that can be filled out electronically, please call the Division of Continuing Medical Education at (319) 335-8599 and ask to speak to one of our program coordinators. We ask that you not type over your previous year's application because you may not be working with the most current document. The application must be filled out by the course director to receive approval.

Commercial Support

Written Agreement for Commercial Support

This form must be filled out and signed every time a commercial company contributes financial support to an educational activity. A commercial supporter is defined by the ACCME as a company that manufactures health care products used on patients. Examples would include pharmaceutical companies, medical device companies, and medical equipment companies. 

  • All commercial support funding must come through the CME office or your departmental administrator.
  • Please be sure you are familiar with UI Health Care's Conflict of Interest Policy.
  • Speakers may not receive payments directly from commercial companies. UI Health Care faculty are not allowed to participate in Speaker's Bureaus for industry.
  • Food and catering expenses may not be purchased directly by companies and brought to the educational program. Funding must go to the department or CME office who may opt to use the funding for meals or snacks.

Conflict of Interest Disclosure and Review

Every speaker and planning committee member is required to disclose relevant financial relationships before they present or participate in the planning of a CME activity. Per updated ACCME standards, anyone who does not disclose may not participate in the planning or presentation of a CME activity (see Standard 2.2). The course director or CME office must review disclosures and resolve conflicts of interest for planning committee members and speakers before individuals can be included in a program.

UI Health Care Speakers & Planning Committee Members

Non-UI Health Care Speakers & Planning Committee Members

Disclosure to Learners

All financial disclosures must be made known to attendees before the program or presentation begins. This can be accomplished in a variety of ways, including in a slide, verbal disclosure by the presenter or moderator, or in a handout included in the syllabus. Click the following link for a sample script that speakers and instructors can use to verbally disclose their financial relationships:  Script for Disclosure 

Course Director Verification 

Course Directors should fill out and sign the Course Director Verification form within two weeks of the completion of a program (at the end of the fiscal year for RSS). This will serve as confirmation that financial disclosures were reviewed prior to each session, and that conflicts of interest were resolved, as well as confirming that disclosures were made known to learners. PLEASE NOTE:  THIS FORM IS TO BE COMPLETED BY THE COURSE DIRECTOR--NOT SPEAKERS. 

Honoraria Policy 

The ACCME now requires the accredited provider (Carver College of Medicine) to have an honoraria policy in place to further ensure that all presentations are free of commercial bias. Please be sure to review the four elements on the last page of this policy before offering your speakers honoraria. The current cap is $2,000 per presentation.


Additional Forms

Change Form

Every attendee should be given a change form to fill out if they do not attend the entire meeting (for example, if they arrive late or leave early or miss some of the presentations.) Return the completed forms to our office so that credit can be assigned accordingly.

Checklist of Required Forms and Documentation 

Use this list to make sure you understand and have procedures in place for all requirements.

Brochure Template

If you have requested CME credit for your program, no announcements may be sent out without pre-approval from the Division of Continuing Medical Education. The brochure template can be used as a guide for required information and wording, even if your only announcement is on a website or in a letter.

Sample Evaluation Form

Every CME activity must have an evaluation process in place that links outcomes to educational objectives.


RSS Attendance Reporting

Attendance Reporting Web Application  

Upload attendance here at the completion of each session. Requires collection of University of Iowa ID numbers. Contact Leann Hotchkiss at leann-hotchkiss@uiowa.edu if you need access to the application.

Attendance Application User Instructions


RSS Additional Forms

Announcement Template

Announcements of RSS sessions, regardless of the format used, must contain all of the elements found in the Announcement Template.

FileEvaluation Template

RSS must be evaluated at least twice yearly to determine if changes in learner competence, performance, and/or patient outcomes have occurred, as well as whether or not learners have detected commercial bias in any presentations. Please see the Regularly Scheduled Series Policies & Procedures for more information on series evaluation procedures.