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Name all entities with whom you have this relationship or indicate none (add rows as needed) |
Specifications/Comments (e.g., if payments were made to you or to your institution) |
1 |
All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) No time limit for this item. |
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2 |
Grants or contracts from any entity (if not indicated in item #1 above). |
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5 |
Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events |
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6 |
Payment for expert testimony |
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7 |
Support for attending meetings and/or travel |
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8 |
Patents planned, issued or pending |
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9 |
Participation on a Data Safety Monitoring Board or Advisory Board |
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10 |
Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid |
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11 |
Stock or stock options |
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12 |
Receipt of equipment, materials, drugs, medical writing, gifts or other services |
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13 |
Other financial or non-financial interests |
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