Disclosure of Financial Relationships and Off-label/Unapproved Uses

Activity Title: East Meets West: A Holistic Approach to Health

Activity Date: January 18-21, 2019

Presentation Title: Ayurveda: Catalyst to the modern life

☒Speaker/ ☐Planning Committee Member Name: Anand Yadav

It is the policy of the Office of Continuing Education (OCE) at UTMB to ensure balance, independence, objectivity and scientific rigor
in all of its sponsored or jointly sponsored educational programs.

Conflicts of interest exist when person(s) involved in program planning and/or implementation have financial relationships or
personal considerations which could potentially influence the person’s ability to be objective and unbiased in performance of
program-related duties.

The Accreditation Council for Continuing Medical Education (ACCME) requires that we document and disclose ANY financial or other
relationships faculty have with any commercial interest (any entity producing, marketing, re-selling, or distributing health care
goods or services consumed by, or used on, patients). The intent of this policy is to openly identify any such relationships so that
the OCE can identify any conflict of interest which may have been created so that learners may form their own opinions as to
whether the speaker’s presentation reflects possible bias in either exposition or conclusion.

Part I: Disclosure of Financial Relationships

Please indicate all relationships with commercial interests during the past 12 months.
Commercial Interest: See definition above.
Financial Relationships: Relationships where the individual benefits by receiving a salary, royalty, intellectual property rights,
consulting fee, honoraria, ownership interest (stock, stock options or other ownership interest, excluding diversified mutual funds)
or other financial benefit. Financial benefits are associated with roles such as employment, management position, independent
contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review
panels, board membership, and other activities from remuneration is received or expected.

Do you or your spouse/partner presently (past 12 months) have any financial relationships with commercial
interests as defined above? ☐ Yes ☒ No

If yes, please indicate the commercial interest (pharmaceutical or medical device company) below.
Financial Relationship Commercial Interest

Employer _________________________________________________________

Grant/Research Support _________________________________________________________

Consultant _________________________________________________________

Speakers Bureau _________________________________________________________

Major Stock Shareholder/Board Member _________________________________________________________

Other Financial/Material Support _________________________________________________________

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Part II: Disclosure of Off-label/Unapproved Uses
FDA Disclosure: If you mention off-label or unapproved use of a medical device or drug you MUST disclose to
the audience that the use is off-label and/or not approved by the FDA distribution in the United States.

Part III: Content Validation

My recommendations regarding clinical medicine in this CME activity will be based on evidence that is
accepted within the profession of medicine as adequate justification for their indications and
contraindications in the care of patients. All scientific research referred to, reported or used in CME in support
or justification of a patient care recommendation will conform to the generally accepted standards of
experimental design, data collection and analysis.

Part IV: Required Signature

I, Anand Yadav have read and disclosed the appropriate information above. If my presentation includes off-
label/unapproved use of drugs or medical devices, I will disclose this information to the audience during my presentation. Any
recommendations I make regarding clinical medicine will be based on evidence that is accepted within the profession of medicine as
adequate justification for their indications and contraindications in patient care.

Signature: _______ ________ Date: ____1/1/2019_________________________

FOR CME/CNE OFFICE USE (OCE signature will be required for all presenters who have relevant financial relationships. OCE reserve
the right to determine relevance of the relationship.)

☐ No relevant conflict of interest identified.

If a potential influence from commercial interest/conflict of interest is identified, it will be resolved as follows:
☐ Select another individual to control that part of the content.
☐ Change the assignment to reflect other areas of content.
☐ Do not designate presentation for credit.

UTMB OCE Signature: ________________________________________________ Date: ___________________________

Brenda Johnson, MEd, CHCP
Director, Office of Continuing Education

Return to: jskpandya@gmail.com

UTMB Office of Continuing Education, 301 University Blvd – Rte 0151, Galveston, TX 77555-0151
Office 409-772-9300 Fax 409-772-9333 www.UTcme.net