Financial Disclosure Statement - More Info
The purpose of this form is to ensure that any potential or actual conflicts of interest related to a research study are disclosed, evaluated and resolved before the study is undertaken.
Investigators* must complete this form under the Virginia Mason Health System Policy on Conflicts of Interest and Fiduciary Duties (the "Policy") before performing a new research study, and update it if their circumstances change and upon annual review of the study. Electronic Financial Disclosure Statements are accepted for all other key personnel without a known conflict of interest. Any key personnel with a known conflict of interest must fill out the BRI Finanacial Disclosrue statement.
Financial Interest - means anything of monetary value, held either directly or indirectly, by an Investigator or an Investigator’s spouse, domestic partner, or dependent children, including,
- ownership or investment interests, including stocks; stock options; real estate, business or intellectual property interests (patents, copyrights, trademarks); or
- compensation arrangements, including salary, cash equivalent compensation (e.g. equipment), payments for services, consulting fees, royalty payments or honoraria; or
- potential ownership or investment interests or compensation arrangements.
*Exceptions: Research personnel for studies approved by an IRB holding a Cooperative Agreement with the BRI IRB (UW, FHCRC, Group Health Cooperative or Swedish Medical Center) do not need to submit this form.
Financial Relationship Disclosure Statement
E Financial Disclosure Statement (Email Template) Instructions follow:
- The RA or Coordinator will complete the highlighted fields before sending the document to all Key Personnel for review and return response.
- A line must be checked by the Key Personnel and reply sent via their email to meet Institution Policy.
- The PI must still complete the hardcopy version.
- Any Key Personnel WITH A CONFLICT must complete the hardcopy to limit rework by the research or legal staff.
- We ask that a copy of all the emails be maintained in the Regulatory File and submitted to the IRB upon initial review and annually thereafter until completion of the study