Get Speaker Disclosure Declaration Form - District Of Columbia Medicaid

The Speaker Disclosure Declaration Form is a vital document for individuals presenting to the Medicaid Pharmacy and Therapeutics Committee in the District of Columbia. This guide provides detailed instructions to ensure that users can accurately complete the form online and fulfill their disclosure obligations.

Follow the steps to fill out the Speaker Disclosure Declaration Form online.

1. Press the ‘Get Form’ button to access the Speaker Disclosure Declaration Form and open it in your chosen editor.
2. Begin filling out the form by indicating whether you or an immediate family member has a vested interest or affiliation with a corporate organization. Check the appropriate box to indicate your situation.
3. If you have any affiliations, list the name of the organization in the designated area on the form.
4. Complete the fields regarding your relationship with the organization, including whether you are employed by, receive grant/research support from, act as a consultant for, serve as a clinical investigator for, belong to a speaker’s bureau for, hold major stock, or receive other financial/material support from that organization.
5. Clearly print your name in the specified section and provide your signature to certify the information presented is accurate.
6. Finally, fill in the date of submission in the appropriate space.
7. Once you have completed all sections of the form, save your changes, and proceed to download or print the form for your records, or share it as necessary.

Complete your Speaker Disclosure Declaration Form online today to ensure a smooth and compliant presentation.