Relevant Financial Relationships(Required)
I will disclose all relevant financial and subsequent relationships (if applicable) to learners verbally and on a slide at the beginning of my presentation, should I have any.
Commercial Interest(Required)
My contributions will not promote the products or services of any commercial interest to this content, unless previously discussed with the Program Manager.
My Contributions(Required)
I will base my contributions on the best scientific evidence available regarding this content. My contributions will give a balanced view of therapeutic options and be unbiased.
Reviewed the ACR, RSNA & SIIM PHI in Educational Presentations & Edited My Presentation to Comply(Required)
I attest that I have reviewed the ACR, RSNA & SIIM PHI in Educational Presentations Statement and edited my presentation to ensure that it does not contain content of a defamatory and/or discriminatory nature, including but not limited to age, sex, race, religion, gender, disabilities, etc.
Trade Names, Screenshots, & Vendor Logos(Required)
To ensure a non-biased view, I will refrain from using trade names and logos of health care products or services, unless previously discussed with the Program Manager. I have ensured that any screenshots obtained are approved by vendors for educational use (with logos blurred, if necessary).
HIPAA Compliant(Required)
My presentation is HIPAA compliant (e.g. I have only used de-identified patient information). I attest that I have reviewed the PHI in Educational Presentation guidelines and that my presentation adheres to those guidelines.
Permission to Reproduce(Required)
I hereby grant SIIM an unlimited, non-exclusive license to reproduce and distribute my webinar presentation in part or in its entirety and in any format for educational, promotional, or other official purposes of SIIM. By agreeing below, I warrant that I am the sole owner of the materials submitted, that the materials are original and not libelous, and/or that I have the legal authority to grant this license to SIIM. Further, I warrant that these materials do not infringe on any statutory or common-law intellectual property rights or right of privacy of any individual or organization. In the case of authors and presenters who are officers or employees of the U.S. Government, SIIM recognizes that works prepared by them as part of their official government duties are in the public domain.
All intellectual property rights in the design, organization, graphics, and/or content of any and all materials in this binder are owned either by the Society for Imaging Informatics in Medicine ("SIIM") or by their respective authors, who have granted permission to SIIM to compile, reproduce, and distribute them for official purposes. No reproductions, redistribution, or other copying of these materials may be made without the express written permission of SIIM or the designated copyright owner.
Media Release(Required)
I hereby grant permission, for the term of my membership, to the Society for Imaging Informatics in Medicine (SIIM) to use, publish, reproduce, and/or disseminate, in any form or media, any film, video, audio, or photo containing my likeness, image, or speech for the purpose of creating agendas, program materials and handouts or otherwise promoting its programs, meetings, or symposia. SIIM may copyright and distribute materials containing the film, video, audio, or photograph without further approval from me, and I hereby waive any claims I might have against SIIM related to such appearance(s) in the final product(s).
Compliance & Agreement(Required)
I have read and considered each item in this form and have completed it to the best of my ability. I understand that my presentation will be evaluated for fair balance and I may be removed from the program at any time, should I not comply (e.g. commercial bias). By checking the box below and providing my name and email, I attest that I agree to all of the questions above.