Joint Providership Forms

Joint Providership Application

  1. This form is designed to ensure that the FMA collects the necessary information and documentation needed to demonstrate compliance with its accreditation requirements.  The form is also designed to assist the joint providership partner in planning and implementing an educational activity in accordance with adult learning theory that will help support changes in physician knowledge, competence and/or performance.
  2. Note that the Activity Director must be a current member of the Florida Medical Association.

Planner/Faculty Form (List document)

  1. This form is designed to provide the FMA a list of individuals in a position to control content and assist us in tracking this information so that we can make sure that the documentation needed is collected.  The form (also downloadable on Page 3 of the application) serves as a tracking tool and doesn’t take the place of the FMA Disclosure Form.  The form is also designed to assist the joint providership partner in planning and collecting of the FMA Disclosure Forms.

FMA Disclosure Form

  1. This form is designed to elicit information regarding an individual’s financial relationships with ineligible companies whose products or services have a direct bearing on the subject matter of the presentations.  CME providers must ensure that the content presented during an approved activity is objective and unbiased by any individual’s financial interests.  Having a relevant financial relationship does not exclude an individual from participating as a planner or speaker; however we must clearly demonstrate that financial relationships had no influence over the choice of speakers, topics, or the final content delivered.
  2. Planners include all physicians, other healthcare professionals, and staff affiliated with the joint providership partner who had responsibility for influencing content by identifying topics choosing speakers, suggesting and approving final content, etc.
  3. Faculty members include speakers, moderators, panelists, abstract authors and co-authors.

Commercial Supporters Form (List document)

  1. This form (also downloadable on Page 4 of the application) is designed to ensure that the FMA collects the necessary information and documentation needed to demonstrate compliance with its accreditation requirements when Commercial Support (both financial and in-kind) is being applied for

Letter of Agreement (Commercial Support)

  1. Commercial support is financial or in-kind (e.g. services or products) contributions given by an ineligible company (any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients) which is used to pay all or part of the costs of a CME activity.
  2. This does not include fees paid by vendors for an exhibit booth or companies which pay corporate sponsorships in exchange for ads, booth space or other tangible benefits.