Instructions on How to Correctly Fill Out Bio/Disclosure Form

Step 1: Fill out Header

  • Title, Activity Number, Start Date
    * Suggestion – pre-complete the header for all bio/disclosure forms before sending them out.
  • Date Submitted
    * Can be the same date they signed the form or after
  • Notice the format is – mm/dd/yyyy
  • Role in Educational Activity
  • Suggestion – pre-mark these boxes.
  • If only a planner - mark planner. If a presenter – mark that box, if they play both roles – planner and presenter then mark both boxes.
  • Section 1: Demographic Data
  • All fields must be completed
  • Name, credentials….This most match identically with what they enter as their signature in Section 6
  • Position/title
  • Current Employer/address
  • Phone
  • Email address
  • Suggestion – highlight in yellow the requested data categories
  • Section 2: Education/Expertise
  • Suggestion – list degrees and institutions but also if claiming any sort of credential – show the year received, certificate number, institution (as appropriate)
  • Example – CHES, 2007, Certificate Number 123455
  • Describe expertise specific to the educational activity…really we need work experience cut and pasted from their CV and placed here. If they don’t want to fill this out – they can type “See CV” and then we can refer to their CV for this information. This must be a more detailed description than “I have worked 15 years in the field of______and am an expert in my area.”
  • This second box often is not filled out completely.
  • Section 3: Conflict of Interest
  • There is a section for Federal employees and a separate one for Non-federal employees. Planners and Presenters mark only one or the other – NOT BOTH.
  • Federal employees (even ones that have worked less than 12 months should mark “yes”
  • Non-federal employees mark either yes or no.
  • If “yes” – they note in the chart below what their financial conflict is
  • Section 4: Unlabeled Use
  • Planners skip this
  • Presenters must complete
  • Unlabeled use is when the presenter is talking and including information about unlabeled use of commercial products or products for investigational use.
  • Be sure if “yes” is checked to explain the use of unlabeled products in space provided
  • Section 5: Title of Presentation
  • Planners skip this
  • Must be complete for presenters
  • Suggestion – complete this for the presenter and use the “coding” for the session along with the exact title you use on your agenda. The same title will be used on your EPT, course evaluation, and Presenters Checklist.
  • Section 6: Best Available Knowledge
  • Rationale – it verifies that presenter is presenting the most current available information to the audience.
  • Section 7: Statement of Understanding
  • We need to have all bio/disclosure forms as Word documents
  • The signature needs to be typed in, no locked signatures, or hand signed documents in PDF format
  • The signature should look identical as the name and credentials in Section 1 first line. Example: John Smith, MD, MPH in Section 1 should be “signed” John Smith, MD, MPH in Section 7.
  • It is critical that it is dated as well
  • Suggestion: highlight in yellow information below the signature box and date box. See example.
  • Gray Box at the bottom of the form – for Developer.
  • If a presenter or planner has noted a conflict of interest either in Section 3 on this form, you must check off how you will address it.
  • You will also use the information on the bio/disclosure forms to complete the Planner and Presenter Checklists. You will cut and paste the information found in Section 1 to complete the required information on those forms.
  • Bio/disclosure form information on presenters will be used to complete the agenda, EPT, and course evaluation. All the presenter information on these forms must be congruent with the information on the bio/disclosure forms. Hence the critical importance in getting the bio/disclosure forms done well.

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