Maria Andree

	I have disclosed to ICMI all relevant financial relationships, and hereby allow ICMI to disclose this information to learners in print.
	The content and/or presentation of the information with which I am involved, including any presentation of therapeutic options, will be well-balanced, evidence-based, and will not promote specific proprietary business interests of a commercial interest. Any product identification will be made using the generic names to the extent possible. In addition, any off-label use of a medication will be specifically disclosed.
	I have not and will not accept any additional honoraria, payments or reimbursements beyond that which has been agreed upon directly with ICMI.
	If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principles and methods, and will not promote the commercial interest of the funding company.
	To the best of my ability, I will ensure that any speakers or content I suggest is independent of commercial bias.
	I will recuse myself from planning activity content in which I have a conflict of interest.
	1. I will insure balance, independence, objectivity, and scientific rigor in my role in the planning, development or presentation of this CME activity.
	2. I will comply with the requirements to protect health information under the Health Insurance Portability & Accountability Act of 1996 (HIPAA).
	3. I will disclose any discussion or reference to unapproved or unlabeled uses of therapeutic agents or products.
	4. I have input my full name below as attestation of agreement with declaration statements. Marking the check box and indicating my name is in lieu of signature and is considered an "e-signature".