Form E – Letter of Agreement

/ Mount Sinai Medical Center / The Page and William Black Post-Graduate School
Mount Sinai Hospital / Mount Sinai School of Medicine
Mount Sinai School of Medicine
One Gustave Levy Place
New York, NY 10029-6574 / Box 1193
Tel: (212) 731-7950
Fax: (646) 537-9203

Form E

Co-Sponsorship Letter of Agreement

This Letter of Agreement is to confirm that the

______

is entering a “Co-Sponsorship” relationship with

Mount Sinai School of Medicine (MSSM)

Post-Graduate School for Continuing Medical Education

in order to develop the CME activity entitled:

______

to be held at:

______

(location)

on

______

(date)

Co-sponsorship, as defined by the Office of CME at Mount Sinai, is a “collaborative educational relationship” between two ACCME –accredited providers through which Mount Sinai OCME has the sole responsibility over the CME activity.

In a co-sponsorship, each participating organization has certain obligations and responsibilities.

Mount Sinai’s responsibilities are:

1.  For all CME activities to address learning gaps of learners’ current or potential scope of practice in terms of improving competence and/or performance in practice and/or patient outcomes;

2.  To comply with the Essentials, Elements, Standards and Policies of the Accreditation Council for Continuing Medical Education (ACCME); the American Medical Association (AMA) rules, and all MSSM Policies;

3.  To approve all literature, brochures, official correspondence, signage, name tags, handouts, etc.;

4.  To retain final approval rights for all program faculty and program content;

5.  To approve all budget items for the activity – including but not limited to honoraria, reimbursements, tuition, and grants;

6.  To comply with the AMA Guidelines on Gifts to Physicians from Industry;

7.  To comply with Mount Sinai’s Policy of Identifying and Resolving Conflicts of Interest in CME and Content Validation policies and all speakers/authors/moderators/planning committee members (i.e. anyone in the position to control the content of the CME activity) must complete the MSSM-CME Faculty Disclosure Form (Form C).

8.  To approve mass-marketing of the CME activity;

9.  To comply with the ACCME’s Standard for Commercial Support, Standards for Enduring Materials;

10.  To comply with OCME Internet policies, which includes that drug advertisement of any kind is not permitted within the text or adjacent to the text in the online-based enduring materials;

11.  To receive grant support from pharmaceutical/device companies.

12.  To recognize the grantors) as the supporter of this CME activity. Printed materials will read:

“this CME activity is made possible by an unrestricted educational grant from <supporter>.”

13.  To use appropriate co-sponsorship language on printed and online materials related to this CME activity;

14.  To keep ALL records related to this CME activity (must keep participants’ records for six (6) years.

Co-Sponsor’s responsibilities:

To receive Mount Sinai OCME’s approval of any marketing materials, hand-outs, and printed materials prior to their distribution.

It is recognized and confirmed that both co-sponsors of this agreement have veto authority over the educational content of the CME activity. The intent of this document is to articulate the responsibilities Mount Sinai, entity, must uphold. These responsibilities cannot be transferred, delegated or compromised.

Please indicate with your signature, on behalf of your organization, that the above provisions are understood and accepted as the basis of applying for Co-Sponsorship with Mount Sinai School of Medicine.

____________

Signature of Co-Sponsor Alfie Truchan, Director, CME, MSSM

______

Title Date

______

Date