Mount SinaiHospital
Mount SinaiSchoolof Medicine
One Gustave L. Levy Place
New York, NY 10029-6574
Written Agreement for Commercial Support of Mount SinaiEducationalActivities
Outside the Scope of CME
Mount Sinaiis committed to presenting educational activities that promote improvements and quality in healthcare and research,and are independent of the control of commercial interests. As part of this commitment, Mount Sinai has outlined in this written agreement the terms, conditions, and purposes of commercial support for its educational activities. Commercial Support is defined as a financialcontribution given by a commercial entity[1]which is used to support educational activities at Mount Sinai.
Department Receiving Support:Name of Commercial Entity:
Amount of Educational Grant:
Check Made Payable To:
Address: /
Department of ______
Box # ______
One Gustave L. Levy Place
New York, NY 10029-6574
Terms, Conditions, and Purposes
Independence
1.These funds shall be used to support educational purposes only and will not promote any specific proprietary business interest of the commercial entity.
2.Mount Sinai is responsible for all decisions regarding the identification of educational needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, methods, and evaluation of the educational activities.
Appropriate Use of Commercial Support
3.The Department Chair will be responsible for making decisions regarding the disposition and disbursement of funds from the commercial entity.
4. The commercial entity will not require the Department or any education program organizers to accept advice or services concerning faculty, authors, or participants, nor will the commercial entity influence other educational matters, including content, as conditions of receiving this funding support.
5. All commercial support associated with educational activities will be given with the full knowledge and approval of the Department Chair. No other payments shall be given to the
director of any activity, planning committee members, teachers or authors, joint sponsor, or any others involved with educational activities.
6.Product-promotion material or product-specific advertisement of any type is prohibited in or during educational activities. The juxtaposition of editorial and advertising material on the same products or subjects is not allowed. Live or enduring promotional activities must be kept separate fromeducational activities. Promotional materials cannot be displayed or distributed in the room in which an educational activity is taking place immediately before, during or after the educational activity, nor can sales or promotional activities occur in the space or place of an educational activity.
Disclosure
7. The Department may acknowledgethe commercial support to program participants, in program brochures, syllabi, and in other program materials, and at the time of the activity. Theacknowledgment will not include the use of any trade names or product.
The commercial entity and Mount Sinai agree to abide by the Standards for Commercial Support of Continuing Medical Education of the Accreditation Council for Continuing Medical Education (ACCME) for all educational activities at Mount Sinai.
Recipient Institution: / Mount SinaiSchool of MedicineTax ID Number 13-6171197
Contact Person / E-Mail Address
Phone Number / Fax Number
Name of Commercial Supporter:
Address
City, State, Zip
Contact Person / E-Mail Address
Phone Number / Fax Number
Agreed by Authorized Representatives:
Commercial Supporter: / Chair or Designated Signatory, Mount Sinai
Signature Date / Signature Date
Print Name / Print Name
Title / Title
[1]Commercial entities include but are not limited to: pharmaceutical, biotechnology, office supply, and medical device/supply companies; research supply and equipment companies; medical service providers; billing and collection companies.