ࡱ>  Dbjbj ݫ**mm8 \e$d4*^  *3333333609T392^ 223mm4***2Xm83*23**.0H_"A|/3440d4/99(090 22*2222233222d422229222222222* 3:   Office of Continuing Medical Education (OCME) CME Activity Financial Agreement for WFBH/WFSM Regularly Scheduled Series (RSS) Regularly scheduled series (RSS), e.g. grand rounds, teaching conferences, tumor boards, journal clubs, etc. are defined as a continuous series of typically one-hour CME activities originating in one of Wake Forest Baptist Healths (WFBH)/Wake Forest School of Medicines (WFSM) clinical departments/sections. The OCME certifies RSS on a yearly basis (July 1-June 30). In order to qualify for AMA PRA Category 1 Credit(s)TM, the series must be planned by and for physicians, and the sponsoring department/section takes responsibility for the content, quality, and scientific integrity. Regularly Scheduled Series (RSS) Title:  FORMTEXT        FORMTEXT       Sponsoring Department/Section:  FORMTEXT       Date(s): July 1, 2013-June 30, 2014 Activity Director/Designee:  FORMTEXT       Deduct Fees from the following Department Account #/Chartfield:  FORMTEXT       Fees: Certification Request/CME Application Fee (non-refundable and due at time of submission) $1800 Supporter/Exhibitor Solicitation and Application Submission $50/hour (rounded up to the nearest quarter hour) The OCME is charged with monitoring WFSM-certified CME activities to ensure all Accreditation Council for Continuing Medical Education (ACCME), American Medical Association (AMA), WFBH/WFUHS/WFSM, and other appropriately related guidelines are followed. Institutional policy requires the OCME conduct and manage all solicitation for commercial support, which includes requesting, collecting, depositing, allocating, managing, and reconciling both monies and in-kind donations/equipment loans. Per Person Fee No Charge The OCME is required to track registration and claimed credit for all WFSM-sponsored CME activities certified for AMA PRA Category 1 Credit(s)TM. By keeping electronic records, the OCME is able to document CME participation. Any original paper sign-in sheets should be sent to the OCME as documentation of attendance. In addition, the OCME will work with the Activity Director/Designee to design, summarize, and review the results of an evaluation that assesses items such as learner objectives, quality of the instruction and methodology, any potential bias, enhanced professional effectiveness, educational need, and changes in competence, performance, and/or patient outcomes. Disclaimers: The OCME will not be responsible for mismanagement, misuse, or misappropriation of funds by the Activity Director, the Activity Directors staff, and/or department/section. Activity Directors and their staff and department/section agree to abide by all ACCME, AMA, and WFBH/WFUHS/WFSM policies, procedures, and guidelines and agree to defend, indemnify, and hold harmless WFBH/WFUHS/WFSM, its officers, directors, employees, and agents from and against any and all claims, obligations, liabilities, damages, penalties, losses, costs, charges, and expenses (including reasonable attorneys fees) arising out of the acts or omissions of its employees or agents, or breach of its responsibilities and obligations under this Agreement. This indemnification will survive the expiration or termination of this Agreement. A commercial supporter may require financial and/or educational outcome reports at the conclusion of a supported CME activity; in addition, any unspent funds may be required to be returned. The OCME will complete all required reconciliation as part of the supporter/exhibitor solicitation and application process. Should a CME activity be financially closed at the time of the companys reconciliation request, the Activity Directors department/section will be expected to submit the required amount of funding to the supporting company as outlined in the signed Letter of Agreement. Cancellation Clause: In the event a CME activity is canceled or postponed, all expenses incurred by the OCME as of the date of cancellation or postponement will be reimbursed by the Activity Directors department/section. Additional Terms: The OCME must review and approve all postcards, brochures, e-blasts, and other related publicity prior to any printing, distribution, and/or posting. All honoraria payments must comply with WFSMs Policy on Honoraria and Out of Pocket Expenses for Planners, Teachers, and Authors of CME Activities. Honoraria payments to WFBH/WFSM faculty do incur an institutional fringe charge. This amount is calculated by WFBH Financial Services and will be added as an expense to the CME activity. Any hotel/space contracts (Appendix A) are part of this Agreement. In the case of cancellations, reductions, or other contract adjustments, the Activity Directors department/section will be responsible for payment. (Note: All hotel/resort/conference center and similar contracts must be signed and processed in advance by the WFBH Strategic Sourcing Department.) Northwest Area Health Education Center (Northwest AHEC)/OCME Tech Team assistance for web-based enduring material design, special website registration system needs, etc. will be charged at the prevailing rate. The arrangement for such services will be added as an addendum to this Agreement. The OCME accepts VISA, MasterCard, and American Express as forms of payment. All credit card transactions incur separate bank and transaction fees (calculated as a percentage of the amount charged to the individual credit card). These fees will be added as an expense to the CME activity. The OCME cannot assume any risk/loss for a CME activity. Therefore, it expects to be reimbursed for any and all expenses over and above the income received for the activity. Alternatively, any profit for an activity will be returned to the Activity Directors department/section. Should any expenses occur after the CME activity has been closed, the Activity Directors department/section will be responsible for payment. All CME activities are financially closed within 90 days from the conclusion of the CME activity. At the Activity Directors request, the OCME will provide a current Profit & Loss Statement 45 days from the CME activity end date and discuss either in a face-to-face meeting or documented phone call the status of all income and expenses. Should a CME activity cross fiscal years (July 1-June 30), any income and expenses will be transferred in order to be accounted in the new fiscal year. ___________________________________________________________________________________________________________ As the Activity Director/Designee, I understand and accept the terms and conditions of this Agreement. Signature: _______________________________________________________________ Date: ____________ As the Department Chair/Section Head sponsoring this CME activity, I understand and accept the terms and conditions of this Agreement. 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