EXPLORE THE FACTS
EXPLORE THE FACTS
[Insert Date]
Case Presentation
Disclosure Information
I have no relevant financial relationships to disclose.
I have the following relevant financial relationships to disclose:
Consultant for:
Speaker’s Bureau for:
Grant/Research support from:
Stockholder in:
Honoraria from:
Employee of:
- OR -
I will not discuss off label use or investigational use in my presentation
- OR -
I will discuss the following off label use and/or investigational use
in my presentation:
•
please list….
Disclosure Information
Case Presentation
Age:
Chief Complaint:
Previous Diagnoses and Treatment:
Case Presentation
Current Investigations and findings:
Chart
Labs
Ultrasound
Surgery
Other
Case Presentation
Current Treatment:
Medications
Surgery
Other
Response and Differential Diagnosis:
Case Presentation
Current Questions and Concerns:
Providing a detailed account of a case presentation along with relevant financial disclosure information. Includes information on the patient's age, chief complaint, past diagnoses, current investigations, treatment, and questions. Also includes details on financial relationships and off-label use disclosure.
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Presentation Transcript
EXPLORE THE FACTS Case Presentation [Insert Date]
Disclosure Information I have the following relevant financial relationships to disclose: Consultant for: Speaker s Bureau for: Grant/Research support from: Stockholder in: Honoraria from: Employee of: - OR - I have no relevant financial relationships to disclose.
Disclosure Information I will not discuss off label use or investigational use in my presentation - OR - I will discuss the following off label use and/or investigational use in my presentation: please list .
Case Presentation Age: Chief Complaint: Previous Diagnoses and Treatment:
Case Presentation Current Investigations and findings: Chart Labs Ultrasound Surgery Other
Case Presentation Current Treatment: Medications Surgery Other Response and Differential Diagnosis:
Case Presentation Current Questions and Concerns:
