A. List the names of proprietary entities producing health care goods or services (commercial interests) with the exemption of non-profit or government organizations and non-health care related companies with which you or your spouse/partner have, or have had, a financial relationship within the past 12 months. For this purpose the financial relationships of your spouse or partner that you are aware of to be yours. (note: if you do not have any financial relationships to disclose, please skip to D).
B. Delineate what you or your spouse/partner received (ex: salary, honorarium etc). MSM does NOT want to know how much you or your spouse/partner received.
C. Delineate you or your spouse/partner's role.