Open Forum for Infectious Diseases - Conflict of Interest Disclosure
To receive CME credit for your review, you must save a completed version of this form
and submit it with your review. Be sure to complete both pages!
Reviewers are responsible for disclosing financial and other potential conflicts of interest,
when they are seeking CME credit for their reviews. There is a potential conflict of
interest when anyone involved in the publication process has a financial or other
beneficial interest in the products or concepts mentioned in a submitted manuscript or in
competing products that might bias his or her judgment.
Financial support that the reviewers received should be noted below and disclosures must
include the name of the commercial interest and the relationship (stock, consultant, etc.).
Disclosures should be listed for a 2-year period.
Reviewer Name:
Ms Number:
Article Title:
___ Check here if you have no conflict with any manufacturer of a product discussed
in the manuscript. If this line is not checked, describe in the space below what conflict
you have with a manufacturer of a product discussed in the manuscript.
___ Check here if you have no conflicts of interest to disclose. If this line is not
checked, all conflicts of interest, or any relevant financial relationship, must be listed
below, or on a separate page.
Please list all conflicts for each author in the space provided below.
I certify that I have no conflict with the authors of the above-mentioned manuscript and
have disclosed all conflicts of interest to the Editors.
Date:
EXAMPLE OF DISCLOSURES:
Recent Research Funding: Bayer Corporation, Bristol-Myers Squibb Company
Consultant: AstraZeneca, Aventis Pharmaceuticals
Speakers' Bureau: Pfizer, Inc., Wyeth-Ayerst Laboratories
REVIEWER’S CERTIFIED DISCLOSURES:
Evaluation of Manuscript Review Program
1. The learning objectives were met through participation in the review process.
Yes__
No__
2. This review process prompted me to critically review existing literature.
Yes__
No__
3. This review process prompted me to synthesize the existing literature with the
contents of the proposed manuscript
Yes__
No__
4. This review prompted me to identify the strengths of an area needing
improvement in the proposed manuscript.
Yes__
No__
5. Participating in this review process improved my understanding of the chosen
diagnostic and/or therapeutic techniques(s).
Yes__
No__
6. Please describe what you learned from participating in this manuscript review
process and how you plan to apply it to your practice.
Comments: