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Faculty Disclosure No, nothing to disclose Yes, please specify: Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Equity Position Ownership/ Employee Other (please specify) Example: Company XYZ x x x Off-Label Product Use Will you be presenting or referencing off-label or investigational use of a therapeutic product? No Yes, please specify:

Faculty Disclosure

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Page 1: Faculty Disclosure

Faculty DisclosureNo, nothing to disclose

Yes, please specify:

Company NameHonoraria/Expenses

Consulting/ Advisory Board

Funded Research

Royalties/ Patent

Stock Options

Equity Position

Ownership/ Employee

Other (please specify)

Example: Company XYZ  x x x                          

Off-Label Product Use

Will you be presenting or referencing off-label or investigational use of a therapeutic product?

No

Yes, please specify:

Faculty Disclosure - ucsfcme.com Disclosure No associations with ... ... (gout, hypoK, h/o arrhythmia, etc) is a caution

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