Disclosure of Potential Conflicts of Interest: Authors must complete an ICMJE Conflict of Interest Statement form for each submitted manuscript. DOC Koreanjournal of Otorhinolaryngology-head and Neck Surgery If the authors have no conflict Of interest to declare, they must also state this at submission. 5 Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events ____None 6 Payment for expert I, the author, hereby assign and transfer all copyrights in and to the manuscript named above, in all forms and media of expression now known or later developed, to the Coastal Education and Research Foundation, Inc. [CERF] effective if and when it is accepted for publication in Authors must provide written consent from the participant when clinical descriptions make identification possible. No time limit for this item. You cannot complete a Declaration of Interest form on someone else's behalf. Corresponding author: The purpose of this form is to provide the readers of Rheumatologywith information regarding any interest and relationships that may influence how they read and understand your work. Uniform disclosure forms (1 for each author) The goal of this series is to initiate discussion about controversial but instructive clinical scenarios. Faculty Disclosure of Relevant Financial Relationships . Disclosure: Financial — Author for ABC SLP Publishers and receives royalty payments. Planners, faculty and authors must make full disclosure indicating whether the planner, faculty or author and/or his/her spouse has any relationships with Manuscript number: Author's name (please print): Manuscript title: Each author should complete and return this form to the corresponding author. _____ Author Note Attached _____ _____ Author signature (All contributing authors must sign this form or duplication of thereof) Date 4) I confirm that the given sequence of authors is the consensus of all contributors. Author Disclosure Form To reduce errors in the way that names appear when they are abbreviated, please fill in the following table for all authors: First name(s) Surname/Family name Name as it should appear in abbreviated form E.g., Jane Louise Doe Doe JL Please add extra rows as needed. Conflicts of interest may influence the judgment of authors and reviewers; these conflicts often are not immediately apparent to others or to the reviewer. After your manuscript passes the initial check-in stage, all authors will receive instructions for submitting their online disclosure form. E. Author Warranties and Disclosure The Author represents and warrants the following: The corresponding author should upload one PDF file that includes copyright and disclosure forms for all authors to the Movement Disorders submission site with the revised version of the paper. If you do not have a free AAMC account, click on . Declaration of interest, including grants, fellowships, or commercial assistance or financial sponsorship received; or of any affiliation, organization or entity which is relevant. Our audience includes researchers, health care providers . Disclosures should be entered online at the time of submission. Download All authors should have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. Author disclosure forms. June 2021. Our system aligns with the policies of the AAN and allows the readers to judge whether bias . If you already have a free AAMC account, sign in and start your disclosure. If you include disclosures in the Acknowledgments section or elsewhere in the text, you F. Author Warranties and Disclosure The Author represents and warrants the following: He/She has the right to assign and transfer (unless Authors falls under exceptions listed in Paragraphs C Updated: 8/18/2017 . This author attestation form adheres to the guidance from the International Committee of Medical Journal Editors (ICMJE) including complete and accurate disclosure of all"potential conflicts of interest." Each contributing coauthor should complete the ICMJE form. LEAD AUTHOR DISCLOSURE FORM . Please insert "I (we) declare that we have no conflicts of interest in the authorship or publication of this contribution." Or __ 2. All journals required disclosure of financial COI pertaining to the authors and a minority (35%) asked for financial COI disclosure pertaining to the family members or authors' institution (29%). A conflict of interest exists when an author and/or co-author has financial or personal relationships with other persons or organizations that may influence professional judgment concerning an essential . We focus on methods, concepts, and results related to the financing, organization, delivery, evaluation, and outcomes of health services. Posts online (at NEJM.org) disclosure forms filed by all authors alongside the full text of each article May publish additional information about author contributions in the Methods section of . Convey is a service run by the Association of American Medical Colleges (AAMC) that provides you the ability to securely record and maintain your own financial . III. IUJ Authorship & Disclosure Form Authors should use this form to state financial disclosures and authorship, and submit this along with your manuscript. Faculty Disclosure of Relevant Financial Relationships . Potential conflicts of interest (including sources of funding) will be summarised in a separate section of the published article. These forms can also be emailed to mdjedoffice@gmail.com . Some journals may use different forms or mechanisms for declaring potential conflicts of interest and disclosures, and you should check the information for authors at the journal to which you plan to send your manuscript. AJMC Journals Anniversary Author Forms Authors Nominate a Rising Leader. Disclosure of financial and non-financial relationships and activities a. Pediatrics in Review adheres to ICMJE policy and uses an online disclosure e-form in order for authors to do so. Therefore, disclose all relevant financial relationships only once, not per engagement or role. Guide to Completing Author Disclosure Forms _____ 6. A Declaration of Interest (sometimes called a Disclosure Statement) is a notification from the author that there's no financial/personal interest or belief that could affect their objectivity, or if there is, stating the source and nature of that potential conflict. JBJS will post the forms online and summarize them in a statement in the article. Disclosure represents a commitment . Title: Microsoft Word - PNJ - Author Disclosure Form Author: tornatol Created Date: 3/2/2011 4:43:55 PM Manuscripts will be reviewed only after we have received confirmation of your payment. (for all authors) that might lead to conflict of interest charges stemming from statements made in this article. ICMJE DISCLOSURE FORM Date:__Dec 21, 2021_____ Your Name:__Shawn O'Driscoll_____ Lead author: Name: Disclosure: To prevent ambiguity, authors must state explicitly whether potential competing . ICMJE DISCLOSURE FORM Date:_____Mar. Please indicate your or your spouse/partner or your co-author's financial and organizational relationships by checking the appropriate boxed below. Call for Abstracts Step-by-step instructions • Once you have finalized your author disclosure form, you may start your ATS 2020 abstract submission by clicking on Return to Dashboard in the top menu. Presenting author (submitter) must complete the author disclosure form Back to Table of Contents. Interests outside the 3-year time frame must be disclosed if . Manuscript Identifying Number (if you know it) Section 2. Title page Unstructured text, starts with 'Dear Editor,' One key message (maximum 15 words) References (up to 8) Table/figure (up to 1, not including supplementary material) Word Count: Up to 800 If the relevant information is already included in the manuscript text, do I need to include the information again in the Clinical Chemistry Disclosure Form? Required for all submissions: Author Disclosure Form - the submitting author should submit one form on behalf of all co-authors. Author's Signature Date Please print this form then complete, sign, scan, and upload it into the Journal of Midwifery & Women's Health online system or fax it to (919) 287-2768. All supporting documents must be provided at the time of submission to be considered in the review process. I, the author, hereby assign and transfer all copyrights in and to the manuscript named above, in all forms and media of expression now known or later developed, to the Coastal Education and Research Foundation, Inc. [CERF] effective if and when it is accepted for publication in Submission Fees: $50 for members of the North American Spine Society and $125 for non-members After online submission and check-in of your submission by the Journal staff, authors will be sent an email referring them to a payment page at the Elsevier Webshop. For submission of abstracts to ASCO meetings, submitting authors must enter disclosure of each coauthor into the official Abstract Submitter unless the coauthor has All authors must submit a signed copy of this form before the manuscript will be peer reviewed. __ 1. Disclosure of Potential Conflicts of Interest . All News. 1 All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) Yes No 5. Patient consent must be obtained prior to submission, and the author declaration form must be sent with your submission to Rheumatology. These are typically short vignettes explaining a clinical problem, ideally presenting a correlated figure, and asking 1-4 questions to a set of invited experts. The main outcome measure was test . Required forms. Submit the proposal by the deadline. Author Disclosure Form NOTICE TO EDITORIAL OFFICE PLEASE COMPLETE SECTION B OF THIS FORM BEFORE EXPORTING WITH FINAL FILES SECTION A: Disclosure Statement (to be completed by authors) Manuscript title: Corresponding author: Articles accepted to [JOURNAL NAME] are eligible to earn badges that recognize open scientific Author Disclosure Form Manuscript number: Author's name (please print): Manuscript title: Each author should complete and return this form to the corresponding author. Partners. Title: Microsoft Word - Disclosure Form CRN Speaker Author Moderator Author: danielle.nathan Created Date: 7/11/2018 2:34:28 PM Authors are requested to disclose interests that are directly or indirectly related to the work submitted for publication. Over half required the disclosure of at least one form of non-financial COI (57%), out of which only two (3%) specifically referred to intellectual COI. DISCLOSURE STATEMENT . Competing Interests. Author's signature Author's signature Printed name and date Printed name and date Author's signature Author's signature Printed name and date Printed name and date Completed forms can be scanned and send as an email attachment or submitted by fax to the editorial office: 416-368-4443 Authors Conflicts of Interest Disclosure form. For articles submitted via a submitting agent, the form should be completed by the corresponding author. Thank you for submitting your manuscript to the . Author disclosures (Sections a & b should be completed) I certify that financial and/or material support was received for this research and/or the creation of this work, the sources and extent of involvement of which are clearly identified in the manuscript. 22th, 2021____ Your Name:___ Man-Mei Long __ Manuscript Title:_____ Clinical comparison of tenosynovial giant cell tumors . This disclosure form is now linked to all AANS/NREF/NPA speaking engagements. From technology to trade secrets, confidentiality agreements are helping entrepreneurs everywhere to stake their claim and protect their ideas and . Date 4. Before a manuscript undergoes peer review, the editors must be sure that the authors have disclosed any potential financial or other conflicts of interest related to the manuscript's contents. Save the form on your own computer and check with the journal you are submitting to for specific instructions on how to submit your completed form to them. . Journal of Military, Veteran and Family Health. The ICMJE has developed its Disclosure Form as a means of promoting a standardized approach to such declarations. Examples of a disclosure statement for a single presenter. The collection of forms is automated within the online submission system. American Ophthalmological Society Thesis Author Disclosure Statement Each author is required to fill out this form. ____None Time frame: past 36 months 2 Grants or contracts from any entity (if not indicated in item #1 above). The form is completed electronically. A. IDENTIFYING INFORMATION Author name: E-mail address: Each author must also complete a separate CME conflict of interest disclosure form (attached). Author Disclosure Form (ADF) Corresponding Author Information. All authors must submit a signed copy of this form before the manuscript will be peer reviewed. to transparency and does not necessarily indicate a bias. Author Disclosure Form *This form can be downloaded from the journal homepage 122 www.the-cen.org Section 1. News. Identifying Information 1. The editors You can then scan it and attach it to an email you send to teem@todos-math.org when you submit the manuscript. Disclosure Form This form is provided for use in collecting disclosure information. The primary purpose of HSR is to provide researchers and users of health services research with new knowledge. The corresponding author is encouraged to keep completed forms on . Fill this form in (type or print neatly) and sign it. Email completed forms to FPM Editorial at fpmedit@aafp, or fax to 913-906-6010. ASCO does not collect or store these paper forms. A separate form must be completed for each author listed on the proposed policy statement. Manuscript Title 6. AUTHOR DISCLOSURE FORM. These documents should be completed and submitted alongside article submissions as appropriate. Financial Relationships Disclosure Form For Faculty, Authors, Committee/Board Members, and Staff Organizations accredited by the American Dental Association Continuing Education Recognition Program (ADA CERP) and Accreditation Council for Continuing Medical Education (ACCME) are required to identify and resolve all potential conflicts of Should you encounter any difficulties, please e-mail jmwh@acnm.org Should you encounter any difficulties, please e-mail jmwh@acnm.org AUTHOR DISCLOSURE The form is designed to be completed electronically and stored electronically. Are you the corresponding author? II. Updated: 8/18/2017 . 2. To start the process, click on the 'Start Disclosure for Cochrane' link provided in the email. Confidentiality Agreements, also known as non-disclosure agreements, play a vital role in today's fast-paced and high stakes business world. Manuscript Title: Authors: PLEASE LIST: A) Any commercial or similar _____ relationships of the authors or members of their families to _____ products or companies mentioned in or related to the subject matter _____ . YES. Author statement & ICJME transfer form (PDF file, 45KB) Artwork Guidelines (PDF file, 232kB) Correction Policy (PDF file, 25kB) Creative Commons 4.0 Open Access licences CC BY 4.0 (PDF file, 122kB) CC BY-NC-ND 4.0 (PDF file, 140kB) ICMJE Conflicts of Interest form (Word file, 29KB) Sample Disclosure Form _____ Authors and Co-authors, In the increasingly complex world of scientific publication, concerns about commercial influence and other possible conflicts make it important for authors to disclose all potential sources of bias. Disclosures should be entered online at the time of submission. Confidentiality Agreement for Writers & Authors. For authors Submission guidelines Ethics & disclosures Open Access fees and funding Contact the journal Submit manuscript Explore Online first articles Volumes and issues Sign up for alerts The editor's interest extends to all commercial interests of each of the authors that relate to ophthalmic companies or devices or other related interests in medicine. 1. During the revision submission process, each author must complete 2 electronic forms: Conflict of Interest: AHA Journals use Convey to facilitate the disclosure process. Each author must submit a completed . Required Disclosure: During the past 12 months have you, or your spouse or partner had a . Did you or your institution at any time receive payment or services from a third party (government, commercial sponsor, private foundation etc) for The form should be completed by the Directions: Thank you for your interest in Teaching for Excellence and Equity in Mathematics! It also serves to confirm that all individuals qualify for authorship as set out in the form below. OR HSR Author Instructions: Aims and Scope. Manuscript title: Manuscript ID Affiliation: Telephone/ Fax number: E-mail address: Name(s) of co-author(s): Please select below what´s appropriate and return the completed Author Disclosure Form to the editorial office by email (editor.jab@betasciencepress.com). Author Disclosure Manuscript Title: Author: In accordance with the Uniform Requirements for Manuscripts submitted to Biomedical Journals (International Committee of Medical Journal Editors), authors must disclose all potential or actual conflicts of interest. . Authorship and Disclosure Form Page 1 of 2 (signature required on Page 2) Manuscript ID number (if known): Article title (first few words): Corresponding author: Email address: Full list of co-authors: Please note: It remains the responsibility of the corresponding author to ensure all co-authors are Press Releases. Author Form. personal or financial). Author Disclosure Form . Instructions. Any manuscript submission must include a conflict of interest disclosure statement. Questions? Note: All authors must complete this form. When submitting your proposal: Complete and attach the (1) proposal submission checklist, (2) author disclosure forms (for each author), (3) sponsorship and endorsement letters (if applicable). Media . AUTHOR DISCLOSURE FORM Thank you for submitting your manuscript to the Journal of Military, Veteran and Family Health. ____None 3 Royalties or licenses ____None Disclosure Form. Product Approvals and Launches. The publisher may request that an author's stated commercial or financial connection be disclosed in a footnote; such disclosure will not necessarily suggest that a bias exists. The corresponding author is encouraged to keep completed forms on file for future reference. 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