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ICMJE Form for Disclosure of Potential Conflicts of Interest - acponline 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section 1: Identifying Information. Enter your full name, check if you are the corresponding author, and provide the manuscript title and identifying number.
  3. Move to Section 2: The Work Under Consideration for Publication. Indicate whether you or your institution received any third-party support for the work. Check 'Yes' or 'No' and fill in details as required.
  4. Proceed to Section 3: Relevant Financial Activities Outside the Submitted Work. Report any financial relationships with entities that could influence your work, using one line per entity and adding rows as necessary.
  5. Finally, complete Section 4: Other Relationships. Disclose any additional relationships that may be perceived as influencing your work.

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The ICMJE recommends that an author should meet all four of the following criteria:Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work,Drafting the work or revising it critically for important intellectual content, Final
ICMJE DISCLOSURE FORM Guidance and definitions: This form is to enable you to provide information about financial and non-financial relationships and activities that readers may find pertinent to your work.
The International Committee of Medical Journal Editors (ICMJE) is a group of general medical journal editors meeting regularly and works on Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals (.ICMJE.org).

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icmje form for disclosure of potential conflicts of interest

ICMJE Guidelines for Authorship.doc

conflict-of-interest disclosure forms. When submitting a manuscript authored icmje@acponline.org a: ​ Brief curriculum vitae. ​ Cover letterRead more

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A Disclosure Form for Work Submitted to Medical Journals

by DB Taichman 2020 Cited by 41 A template that enables authors to create disclosures that emulate the extant ICMJE Form for the Disclosure of Potential Conflicts of Interest is alreadyRead more

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