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*, clinical research coordinators and other research personnel (i.e. those responsible for the design, conduct and reporting of a research study) 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. A separate form is required for each individual investigator or other personnel involved with the study.
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.