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Financial Disclosure for CME Activity by Dr. John Smith, MD - St. Mary’s Hospital, Springfield, IL

This document outlines the financial relationships and disclosures for the Continuing Medical Education (CME) activity presented by Dr. John Smith, MD, at St. Mary’s Hospital, Springfield, IL. For the previous 12 months, I disclose that I have received honoraria from the following sources: [insert sources or "None"]. Additionally, I have consulted for: [insert sources or "None"], and I hold common stock in: [insert sources or "None"]. Educational objectives will not include the discussion of investigational products.

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Financial Disclosure for CME Activity by Dr. John Smith, MD - St. Mary’s Hospital, Springfield, IL

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  1. Title SubTitle – Line 1 SubTitle – Line 1 FirstName LastName, MD Hospital Name City, State

  2. Faculty DisclosureName, Degree • For the 12 months preceding this CME activity, I disclose the following types of financial relationships: • Honoraria received from: (or type ‘None’ if applicable) • Consulted for: (or type ‘None’ if applicable) • Held common stock in: (or type ‘None’ if applicable) • Research, clinical trial, or drug study funds received from: (or type ‘None’ if applicable) • I ________ (will OR will not) be discussing products that are investigational or not labeled for use under discussion.

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