American College of Physicians

Department of Clinical Policy Disclosure of Interests: Supplement

Name: Elie Akl, MD, MPH, PhD

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting.

Thank You.

If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Date December 30, 2019

Dec30,201905:47:07ESTAmer icanCol legeofPhysiciansElieAkl

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

Alliancef orHealt hPolicyandSyst emsResearch Grant/Contract Self $180 ,119.00

AmericanCollegeof Rheumatology Grant/Contract Self $96,276.00

Deut scheGesellschaf t f ürInt ernat ionaleZusammenarbeit (GIZ )GmbH Grant/Contract Self $1,275.00

eilNat ionalDeRecherchesScient if iques(CNRS) Grant/Contract Self $25,082.00

Facult yof MedicineMedicalPract icePlan(MPP),AmericanUniversit yof Beirut Grant/Contract Self $36,000 .00

Facult yof MedicineMedicalPract icePlan(MPP),AmericanUniversit yof Beirut Grant/Contract Self $18,000 .00

GlobalEvidenceSynt hesisInit iat ive Grant/Contract Self $255,550 .00

DisclosurePurpose:AnnualGovernanceDisclosure2019

RecipientName:Centerforsystematicreviewsofhealthpolicyandsystemsresearch(SPARK),AmericanUniversityof

RecipientType:InstitutionGrant/ContractDescription:EstablishingarapidresponseservicetoaddressrequestsfrompolicymakersforHPSRinLMICsinthe

Grant/ContractPurpose:Research Grant/ContractAmount:$180 ,119.00Grant/ContractValuationDate:04/05/2019 ContractStartDate:09/01/2016 ContractEndDate:12/18/2018AdditionalInformation:

RecipientName:AUBGRADEcenter RecipientType:InstitutionGrant/ContractDescription:Conductingsystematicreviewsforthe2020udpateoftheAmericanCollegeofRheumathology(ACR)gui

Grant/ContractPurpose:ResearchGrant/ContractAmount:$96,276.00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:08/01/2018 ContractEndDate:12/01/2020AdditionalInformation:

RecipientName:AUBGRADECenter,AmericanUniversityofBeirut(AUB) RecipientType:IndividualGrant/ContractDescription:SupportINASantéinTunisiaindevelopingthecapacitytoadaptclinicalpracticeguidelines

Grant/ContractPurpose:ResearchGrant/ContractAmount:$1,275.00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:07/01/2018 ContractEndDate:12/01/2018AdditionalInformation:

RecipientName:CenterforSystematicReviewsinHealthPolicyandSystemsResearch(SPARK)

RecipientType:InstitutionGrant/ContractDescription:Applyinganimpact-orientedapproachtosupport,protectandaddresstheneedsofHealthCareWorker

Grant/ContractPurpose:Research Grant/ContractAmount:$25,082.00Grant/ContractValuationDate:04/05/2019 ContractStartDate:01/01/2018 ContractEndDate:12/30 /2019AdditionalInformation:

RecipientName:ElieAkl RecipientType:IndividualGrant/ContractDescription:Developingamethodologyforverifyingtheaccuracyandcompletenessofconflictofinterestdisclos

Grant/ContractPurpose:ResearchGrant/ContractAmount:$36,000 .00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:07/01/2017 ContractEndDate:06/01/2019AdditionalInformation:

RecipientName:ClinicalResearchInstitute,AmericanUniversityofBeirut RecipientType:InstitutionGrant/ContractDescription:Intellectualconflictwhenconsideringtreatmentoptions(INCONFLICT)

Grant/ContractPurpose:ResearchGrant/ContractAmount:$18,000 .00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:02/01/2015 ContractEndDate:02/01/2017AdditionalInformation:

Int ernat ionalLeagueAgainst Rheumat ism(ILAR) Grant/Contract Self $25,000 .00

Nat ionalInst it ut ef orHealt hResearch Grant/Contract Self $13,083.00

WorldHealt hOrganizat ion Grant/Contract Self $5,400 .00

AdditionalInformation:

RecipientName:Centerforsystematicreviewsofhealthpolicyandsystemsresearch(SPARK),AmericanUniversityof

RecipientType:InstitutionGrant/ContractDescription:HostingSecretariatfortheGlobalEvidenceSynthesisInitiative(GESI)

Grant/ContractPurpose:Research Grant/ContractAmount:$255,550 .00Grant/ContractValuationDate:04/05/2019 ContractStartDate:06/01/2016 ContractEndDate:06/01/2019AdditionalInformation:

RecipientName:AUBGRADEcenter RecipientType:InstitutionGrant/ContractDescription:Adaptationofthe2015AmericanCollegeofRheumatology(ACR)RheumatoidArthritisguidelinesforth

Grant/ContractPurpose:ResearchGrant/ContractAmount:$25,000 .00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:02/01/2017 ContractEndDate:02/01/2018AdditionalInformation:

RecipientName:ClinicalResearchInstitute(AUB) RecipientType:InstitutionGrant/ContractDescription:UpdatingCochranesystematicreviewsonanticoagulationinpatientswithcancer

Grant/ContractPurpose:ResearchGrant/ContractAmount:$13,083.00

Grant/ContractValuationDate: ContractStartDate:01/01/2018 ContractEndDate:12/31/2018AdditionalInformation:

RecipientName:ElieAkl RecipientType:IndividualGrant/ContractDescription:serveasaguidelinemethodologistfortheWHOguidelinesonAfricanTrypanosomiasis

Grant/ContractPurpose:ResearchGrant/ContractAmount:$5,400 .00

Grant/ContractValuationDate:04/05/2019 ContractStartDate:02/22/2019 ContractEndDate:03/30 /2019AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

None

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsof

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

part icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Jan02,202011:44:34ESTAmer icanCol legeofPhysiciansLauraBaldwin

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizations

DisclosurePurpose:AnnualStaffDisclosure2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPgovernancegrouporasCollegest af f ,aspart of ACP'sannualdisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof oneof t hef ollowinggroups:ACPboard,commit t ee,council,t askf orce,and/orot hergovernancegroup?Chapt erCouncilorot herChapt erleadershiprole?Nat ionalorchapt erst af f ?Annalsof Int ernalMedicineedit orialst af f ?Ot her(meet ingguest s,cont ract ors,aut hors,et c.)

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Participationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Jan02,202010:06:29ESTAmer icanCol legeofPhysiciansKateCarroll

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

AmericanCollegeof Physicians Employment Self -

T heBeasleyFirm,LLC Employment Spouse/Partner -

AdditionalInformation:

DisclosurePurpose:CGC/PMC/SMPC,Entry

Title:Manager,ClinicalPolicy PositionDescription:StartDate:08/26/2014 EndDate: AdditionalInformation:

Title:TechnologySpecialist PositionDescription:StartDate:09/01/2009 EndDate: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Supplement

Name: Robert M. Centor, MD, MACP

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting. Thank You. If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Robert M. Centor, MD, MACP Date 1/9/20

Jan23,202010:04:46ESTAmer icanCol legeofPhysiciansRobertCentor

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

Dynamed Consultant Self $1,000 .00

MDCalc Consultant Self -

Medscape Consultant Self -

NKF Consultant Self -

T heCurbsiders Consultant Self -

U.S.Department of Vet eransAf f airs Employment Self -

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2020

Category:Consultant ConsultantDescription:StartDate:01/01/2019 EndDate: CompensationType:CashOtherCompensation: AnnualCompensation:

Year Amount T ype

2019 $1,000 .00 Estimated

AdditionalInformation:ReviewchaptersforDynamed-receive$500 perchapterreview

Category:Consultant ConsultantDescription:StartDate:01/01/2018 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Ontheadvisoryboard

Category:Consultant ConsultantDescription:StartDate:01/01/2019 EndDate: CompensationType:CashOtherCompensation: AnnualCompensation:AdditionalInformation:OccasionallyIwriteapieceandtheypaymeupto$1000

Category:Consultant ConsultantDescription:StartDate:01/01/2019 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:MemberofanNKFperformancemeasuredevelopmentcommittee

Category:Consultant ConsultantDescription:StartDate:01/01/2018 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Appearasaguestdiscussantontheirpodcast

Title:Physician PositionDescription:Inpatientwardattending3.5monthseachyearStartDate:07/01/1993 EndDate: AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

Iexcludedactivitiesgreaterthan3yearsold

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPgovernancegrouporasCollegest af f ,aspart of ACP'sannualdisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof oneof t hef ollowinggroups:ACPboard,commit t ee,council,t askf orce,and/orot hergovernancegroup?Chapt erCouncilorot herChapt erleadershiprole?Nat ionalorchapt erst af f ?Annalsof Int ernalMedicineedit orialst af f ?Other(meet ingguest s,cont ract ors,aut hors,et c.)

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Jun24,201917:41:49EDTAmer icanCol legeofPhysiciansDouglasDeLong

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Icertifythattomyknowledgeandbeliefthattheforegoingdisclosureoffinancialandintellectualinterestsiscompleteandtruthful,andIwillpromptlydiscloseanychanges.

DisclosurePurpose:ANNUALGOVERNANCEDISCLOSURE2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Jan14,202011:39:30ESTAmer icanCol legeofPhysiciansSarahDinwiddie

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

AmericanCollegeof Physicians Employment Self -

smartworkingmom.com OtherBusinessOwnership Self -

T ownSport sInt ernat ional Employment Spouse/Partner -

AdditionalInformation:

DisclosurePurpose:AnnualStaffDisclosure2020

Title:Associate,PerformanceMeasurement PositionDescription:Assisttheclinicalpolicydepartmentintheexecutionofallperformancemeasurement-relatedactivities

StartDate:11/14/2014 EndDate: AdditionalInformation:

FormofBusinessDescription:Educationalresourceofferingprovenstrategiesonhowtobuildanonlinebusinessandmonetizeitforpassiveincome

OwnershipCategory:FounderPartnershipCategory:InvestmentAmount:$1,000 .00

InvestmentAmountValuationDate:01/14/2020 AnnualCompensation:AdditionalInformation:

Title:FitnessManager PositionDescription:ManagethepersonaltrainingprogramsforPhiladelphiaSportsClubeswithinthePAregion

StartDate:09/01/2013 EndDate: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Supplement

Name: Mary Ann Forciea MD MACP

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting. Thank You. If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Mary Ann Forciea MD MACP Date 1/9/2020

Dec24,201915:35:15ESTAmer icanCol legeofPhysiciansMaryForciea

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

Cent erf orMedicareServices Grant/Contract Self -

Nat ionalBoardof MedicalExaminers Consultant Self -

PerelmanSchoolof Medicine,Universit yof Pennsylvania Employment Spouse/Partner -

PerelmanSchoolof Medicine,Universit yof Pennsylvania Employment Self -

T heRalst onCent er FiduciaryOfficer Self -

T IAA-CREFInst it ut e Stock Self -

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2019

RecipientName:UniversityofPennsylvania RecipientType:InstitutionGrant/ContractDescription:DemonstrationProject-IndependenceatHome

Grant/ContractPurpose:Other-HealthServicesResearchGrant/ContractAmount:

Grant/ContractValuationDate:05/03/2019 ContractStartDate: ContractEndDate:06/30 /2020AdditionalInformation:

Category:Consultant ConsultantDescription:StartDate:08/01/2005 EndDate: CompensationType:CashOtherCompensation: AnnualCompensation:AdditionalInformation:

Title:ProfessorofPediatrics PositionDescription:FacultyStartDate:07/01/1980 EndDate: AdditionalInformation:

Title:ClinicalProfessorofMedicine PositionDescription:ClinicalFacultyStartDate:07/01/2000 EndDate:06/28/2019 AdditionalInformation:

OfficialTitle:Member,BoardofManagers PositionDescription:BoardMemberCompensationType:Unpaid OtherCompensation:StartDate:05/01/2006 EndDate:AnnualCompensation:AdditionalInformation:

PercentageOwnership: EstimatedValue:ValuationDate: DivestmentDate:AdditionalInformation:Retirementaccount

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Supplement

Name: Raymond A Haeme

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting. Thank You. If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Date: Jan 3. 2020

Jan03,202015:39:11ESTAmer icanCol legeofPhysiciansRayHaeme

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

DisclosurePurpose:AnnualGovernanceDisclosure2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

YES

Point of Care Ultrasound! □

High flow nasal oxygen! □

Any other intellectual interests that you feel are relevant! D but have not been captured in Convey or above?

NO

�

M

For the Scientific Medical Polic Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Hematuria

Antibiotics

Any other intellectual interests that you feel are relevant! but have not been captured in Convey or above 7;

YES NO

□ �

□

□

DECLARATION ,----;

I certify that to my knowledge and bel· any changes.

Signature

/'/ ,/ ,...

e disclosed my financial and non-financial interests �6�ve �nd I will promptly disclose

/ ✓t'

Date (1t�tm\i/ 2021) ·

Jan09,202017:51:07ESTAmer icanCol legeofPhysiciansPeterHamilton

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)

DisclosurePurpose:AnnualGovernanceDisclosure2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

nil

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Supplement

Name: Russell Harris

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting. Thank You. If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☐

High flow nasal oxygen ☐ ☐

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☐

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Russell Harris Date December 24, 2019

Mar 18,201913:36:59EDTAmer icanCol legeofPhysiciansRussellHarris

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Icertifythattomyknowledgeandbeliefthattheforegoingdisclosureoffinancialandintellectualinterestsiscompleteandtruthful,andIwillpromptlydiscloseanychanges.

DisclosurePurpose:AnnualGovernanceDisclosure2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Dec28,201921:27:54ESTAmer icanCol legeofPhysiciansGregoryHood

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

DisclosurePurpose:AnnualGovernanceDisclosure2019

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

American College of Physicians

Department of Clinical Policy

Disclosure of Interests: Supplement

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests

that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines

Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting.

Thank You.

If in doubt, err on the side of full disclosure

Name: UA.d!w-

Jan13,202017:04:33ESTAmer icanCol legeofPhysicianslindahumphrey

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

Upt oDat e Consultant Self $3,000 .00

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2020

Category:Consultant ConsultantDescription:StartDate:01/01/2010 EndDate: CompensationType:CashOtherCompensation: AnnualCompensation:

Year Amount T ype

2019 $3,000 .00 Estimated

AdditionalInformation:Iwriteachapteronlungcancerscreeningandreceiveroyaltiesthattypicallyarearound3kperyear

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

asabove.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeof

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Physician’sAnt i-Harassment Policy.

Yes

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Supplement

Name: Janet Jokela

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting. Thank You. If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Janet Jokela Date 01/09/2020

Jan22,202012:46:33ESTAmer icanCol legeofPhysiciansJanetJokela

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy

Value

AAMC,Ent rust ableProf essionalAct ivit iesCoreWorkingGroup,UnivILCollegeof Medt eam(member)

Other Self -

AmericanBoardof MedicalSpecialt ies,Commit t eeonCert if icat ion(COCERT )member Other Self -

AmericanCollegeof Physicians Other Self $15,000 .00

ChampaignCount yAudubonBoardmember Other Self -

MississippiValleyRegionalBloodCent er FiduciaryOfficer

Self -

Universit yof Illinoisat Urbana-Champaign Employment Spouse/Partner -

Universit yof IllinoisCollegeof Medicineat Urbana-Champaign Employment Self -

DisclosurePurpose:January2020 GovernanceDisclosure

Category:Other ConsultantDescription:StartDate:07/01/2014 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

Category:Other ConsultantDescription:StartDate:03/01/2017 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

Category:Other ConsultantDescription:StartDate:01/22/2020 EndDate: CompensationType:CashOtherCompensation: AnnualCompensation:

Year Amount T ype

2020 $15,000 .00 Estimated

AdditionalInformation:MKSAPDeputyEditor

Category:Other ConsultantDescription:StartDate:02/01/2000 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

OfficialTitle:Boardmember PositionDescription:serveasamemberoftheMVRBCBoardasafiduciaryofficer

CompensationType:Unpaid OtherCompensation:StartDate:02/01/2018 EndDate:AnnualCompensation:AdditionalInformation:

Title:Professor PositionDescription:FoundersProfessor,CollegeofEngineering,DepartmentofComputerScience

StartDate:08/15/1999 EndDate: AdditionalInformation:

VAIllianaHealt hcareCent er Employment Self -

IntellectualProperty

T ype IsLicensed Int erest HeldBy Value

OtherInt ellect ualPropert y-Nat ionalAcademyof Medicine,st andingcommit t ee... - Spouse/Partner -

OtherInt ellect ualPropert y-NSF,pediat ricvaccineresearch,endedAugust 20 - Spouse/Partner -

OtherInt ellect ualPropert y-NSF,BroaderImpact Init iat ive;AirForceOf f ice... - Spouse/Partner -

AdditionalInformation:

Title:ActingRegionalDean PositionDescription:ChiefAcademicandFiduciaryOfficerfortheregionalcampusoftheUniversityofIllinoisCollegeofMedicineinUrbana

StartDate:02/16/2017 EndDate: AdditionalInformation:myprimaryemployment

Title:InfectiousDiseaseconsultant PositionDescription:StartDate:02/01/2000 EndDate: AdditionalInformation:

Description:NationalAcademyofMedicine,standingcommitteeCDCStrategicNationalStockpile(member)

IncomeSource:

YearlyIncome: AdditionalInformation:

Description:NSF,pediatricvaccineresearch,endedAugust2017 IncomeSource:YearlyIncome: AdditionalInformation:

Description:NSF,BroaderImpactInitiative;AirForceOfficeofScientificResearch,ended02/2018

IncomeSource:NSF

YearlyIncome: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

noadditionalrelevantinfo

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPgovernancegrouporasCollegest af f ,aspart of ACP'sannualdisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof oneof t hef ollowinggroups:ACPboard,commit t ee,council,t askf orce,and/orot hergovernancegroup?Chapt erCouncilorot herChapt erleadershiprole?Nat ionalorchapt erst af f ?Annalsof Int ernalMedicineedit orialst af f ?Other(meet ingguest s,cont ract ors,aut hors,et c.)

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

American College of Physicians

Department of Clinical Policy Disclosure of Interests: Supplement

Name: Devan Kansagara

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting.

Thank You.

If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☒

High flow nasal oxygen ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Date

1/9/20

Jan13,202013:44:06ESTAmer icanCol legeofPhysiciansDevanKansagara

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

DisclosurePurpose:committeemembership

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Jan13,202019:27:50ESTAmer icanCol legeofPhysiciansRachaelLee

SummaryofFinancialInterests

IntellectualProperty

T ype IsLicensed Int erest HeldBy Value

OtherInt ellect ualPropert y-Honoraria - Self $5,000 .00

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2020

Description:Honoraria IncomeSource:YearlyIncome:Amount T ype Year Payment Receipt

$5,000 .00 Actual 2019 DirectPayment

AdditionalInformation:Honorariaforwebinarandlivemeetingoninfluenza

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

IdidonewebinarandonelivemeetingoninfluenzaforPrimeEducationLLCthatisnotrelatedtoworkforACP

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

AmericanCollegeofPhysiciansDepartmentofClinicalPolicy

DisclosureofInterests:Supplement

Name:MauraMarcucci

Purpose:Thisisasupplementaldisclosureofinterests(DOI)worksheettoreportanyintellectualinterests

thatarerelevanttoclinicaltopicsontheagendafortheupcomingClinicalGuidelines

Committee/PerformanceMeasurementCommittee/ScientificMedicalPolicyCommitteemeeting.

ThankYou.

Ifindoubt,erronthesideoffulldisclosure

FortheClinicalGuidelinesCommittee:Inthelast3years,haveyouoranyhouseholdmemberspublishedonanyofthefollowingtopicareas?Pleaseincludebothpeer-reviewedandnon-peer-reviewedsources(e.g.newspaperop-ed;blog)

YES NO

PointofCareUltrasound � �

Highflownasaloxygen � �Anyotherintellectualintereststhatyoufeelarerelevant

buthavenotbeencapturedinConveyorabove?� �

FortheScientificMedicalPolicyCommittee:Inthelast3years,haveyouoranyhouseholdmemberspublishedonanyofthefollowingtopicareas?Pleaseincludebothpeer-reviewedandnon-peer-reviewedsources(e.g.newspaperop-ed;blog)

YES NO

Hematuria� �

Antibiotics� X

Anyotherintellectualintereststhatyoufeelarerelevant

buthavenotbeencapturedinConveyorabove?

� �

DECLARATION

IcertifythattomyknowledgeandbeliefthatIhavedisclosedmyfinancialandnon-financialinterestsaboveandIwillpromptlydiscloseanychanges.

Signature DateJanuary5th,2020

Jan25,202012:50:04ESTAmer icanCol legeofPhysiciansMauraMarcucci

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

CanadianInst it ut esof Healt hResearch Grant/Contract Self $380 ,000 .00

EuropeanCommission Grant/Contract Self -

McMast erUniversit y Employment Self -

Networkof CanadianEmergencyResearchers Other Spouse/Partner -

PSIFoundat ion Grant/Contract Self $230 ,000 .00

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2019,AnnualGovernanceDisclosure2020

RecipientName:MauraMarcucci RecipientType:IndividualGrant/ContractDescription:Granttosupportatrialoninterventionstoreducepostoperativedeliriumandcognitiveoutcome

Grant/ContractPurpose:ResearchGrant/ContractAmount:$380 ,000 .00

Grant/ContractValuationDate: ContractStartDate:10 /01/2019 ContractEndDate:AdditionalInformation:

RecipientName:Fondaz ioneIRCCSCa'Granda,Milan,Italy RecipientType:InstitutionGrant/ContractDescription: Grant/ContractPurpose:Grant/ContractAmount: Grant/ContractValuationDate:01/25/2020ContractStartDate:05/01/2015 ContractEndDate:04/30 /2018 AdditionalInformation:

Title:AssistantProfessor PositionDescription:StartDate:07/01/2017 EndDate: AdditionalInformation:

Category:Other ConsultantDescription:StartDate:01/01/2018 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

RecipientName:MauraMarcucci RecipientType:IndividualGrant/ContractDescription:CareerAward Grant/ContractPurpose:ResearchGrant/ContractAmount:$230 ,000 .00 Grant/ContractValuationDate:01/05/2020ContractStartDate:03/01/2020 ContractEndDate:02/28/2023 AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

none

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPgovernancegrouporasCollegest af f ,aspart of ACP'sannualdisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof oneof t hef ollowinggroups:ACPboard,commit t ee,council,t askf orce,and/orot hergovernancegroup?Chapt erCouncilorot herChapt erleadershiprole?

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Nat ionalorchapt erst af f ?Annalsof Int ernalMedicineedit orialst af f ?Other(meet ingguest s,cont ract ors,aut hors,et c.)

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Jun26,201906:47:37EDTAmer icanCol legeofPhysiciansRobertMcLean

SummaryofFinancialInterests

Ent it y T ype Int erest HeldBy Value

Nort heast MedicalGroup Employment Self -

AdditionalInformation:

Certification

Icertifythattomyknowledgeandbeliefthattheforegoingdisclosureoffinancialandintellectualinterestsiscompleteandtruthful,andIwillpromptly

DisclosurePurpose:annualdisclosure

Title:EmployedPhysician PositionDescription:Physician&MedicalDirectorofClinicalQualityStartDate:11/01/2012 EndDate: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

AmericanCollegeofRheumatologyQualityofCareCommitteetermwasNov2015-Nov2018ABIMRheumatologySub-specialtyBoardtermwasApril2014-June2018

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

discloseanychanges.

Dec26,201917:52:40ESTAmer icanCol legeofPhysiciansAdamObley

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

Advent ist Healt hPort land Other Self $2,500 .00

Cent erf orEvidence-basedPolicy Employment Self -

MedicalSociet yof Met ropolit anPort land FiduciaryOfficer Self -

MilbankMemorialFund Travel Self $10 ,000 .00

Nat ionalConf erenceof St at eLegislat ures Travel Self $1,000 .00

Port landVAMedicalCent er Employment Self -

Schoolof Medicine,OregonHealt handScienceUniversit y Employment Self -

AdditionalInformation:

DisclosurePurpose:AnnualGovernanceDisclosure2019

Category:Other ConsultantDescription:StartDate:09/26/2018 EndDate:09/26/2018 CompensationType:CashOtherCompensation: AnnualCompensation:

Year Amount T ype

2018 $2,500 .00 Actual

AdditionalInformation:Speakinghonorarium

Title:ClinicalEpidemiologist PositionDescription:CEbPsupports0 .5FTEStartDate:08/01/2014 EndDate: AdditionalInformation:

OfficialTitle:Trustee PositionDescription:TrusteeCompensationType:Unpaid OtherCompensation:StartDate:08/01/2015 EndDate:AnnualCompensation:AdditionalInformation:

Location(s):Variousmeetingsandstateworkshops(asfaculty) TravelStartDate:01/01/2015 TravelEndDate:06/01/2019EstimatedValue:$10 ,000 .00 ValuationDate:12/26/2019Purpose:FacultyforEvidence-informedHealthPolicyWorkshops AdditionalInformation:

Location(s):Nashville,TN TravelStartDate:05/05/2018 TravelEndDate:05/07/2018EstimatedValue:$1,000 .00 ValuationDate:12/26/2019Purpose:FacultyforEvidence-informedHealthPolicyWorkshop AdditionalInformation:

Title:StaffPhysician PositionDescription:DivisionofGeneralMedicine,DepartmentofHospitalandSpecialtyMedicine

StartDate:07/01/2013 EndDate: AdditionalInformation:

Title:AssociateProfessorofMedicine PositionDescription:Facultyappointment,notcompensatedStartDate:07/01/2013 EndDate: AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

American College of Physicians

Department of Clinical Policy Disclosure of Interests: Supplement

Name: Adam Obley

Purpose: This is a supplemental disclosure of interests (DOI) worksheet to report any intellectual interests that are relevant to clinical topics on the agenda for the upcoming Clinical Guidelines Committee/Performance Measurement Committee/Scientific Medical Policy Committee meeting.

Thank You.

If in doubt, err on the side of full disclosure

For the Clinical Guidelines Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Point of Care Ultrasound ☐ ☐

High flow nasal oxygen ☐ ☐

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☐

For the Scientific Medical Policy Committee: In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

YES NO

Hematuria ☐ ☒

Antibiotics ☐ ☒

Any other intellectual interests that you feel are relevant but have not been captured in Convey or above?

☐ ☒

DECLARATION

I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Signature Date

Dec03,201915:33:28ESTAmer icanCol legeofPhysiciansAmirQaseem

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

AmericanCollegeof Physicians Employment Self -

Cent ersf orDiseaseCont rolandPrevent ion Other Self -

Cochrane Other Self -

Dynamed Other Self -

Dynamed Other Self -

GRADEWorkingGroup Other Self -

MeasuresApplicat ionPart nership Other Self -

MedBiquit ous Other Self -

DisclosurePurpose:ClinicalPolicy,test

Title:VicePresident PositionDescription:ClinicalPolicyStartDate:12/07/2003 EndDate: AdditionalInformation:

Category:Other ConsultantDescription:StartDate:01/01/2016 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactdates

Category:Other ConsultantDescription:StartDate:06/01/2019 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

Category:Other ConsultantDescription:StartDate:07/01/2014 EndDate: CompensationType:OtherOtherCompensation:honorarium AnnualCompensation:AdditionalInformation:

Category:Other ConsultantDescription:StartDate:01/01/2013 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Idonotknowtheexactstartdate.

Category:Other ConsultantDescription:StartDate:01/01/2003 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Idonothavetheexactstartdate

Category:Other ConsultantDescription:StartDate:01/01/2014 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Idonotremembertheexactstartdate.

Nat ionalAcademiesof Sciences,Engineering,andMedicine Other Self -

Nat ionalQualit yForum Other Self -

Nat ionalQualit yForum Other Self -

Nat ionalQualit yForum Other Self -

PCPI Other Self -

PCPI Other Self -

RIGHT WorkingGroup Other Self -

T homasJef f ersonUniversit y Other Self -

Women'sPrevent iveServicesInit iat ive Other Self -

Category:Other ConsultantDescription:StartDate:01/01/2013 EndDate:01/01/2019 CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:Donothaveexactstartorenddates

Category:Other ConsultantDescription:StartDate:01/01/2019 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactdates

Category:Other ConsultantDescription:StartDate:01/01/2019 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactdates

Category:Other ConsultantDescription:StartDate:01/01/2018 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactdates

Category:Other ConsultantDescription:StartDate:01/01/2015 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Don'thavetheexactstartdate

Category:Other ConsultantDescription:StartDate:01/01/2017 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactstartdate

Category:Other ConsultantDescription:StartDate:01/01/2015 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Donothaveexactstartdate

Category:Other ConsultantDescription:StartDate:01/01/2014 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:Idonothavetheexactstartdate

Category:Other ConsultantDescription:StartDate:01/01/2017 EndDate: CompensationType:OtherCompensation: AnnualCompensation:AdditionalInformation:

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Category:Other ConsultantDescription:StartDate:05/01/2016 EndDate: CompensationType:UnpaidOtherCompensation: AnnualCompensation:AdditionalInformation:don'thavetheexactdates

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

No.

Jan13,202016:54:01ESTAmer icanCol legeofPhysiciansJeffShafiroff

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

AmericanCollegeof Physicians Employment Self -

AdditionalInformation:

Certification

DisclosurePurpose:ClinicalPolicyCommitteesACPStaff

Title:SeniorAnalyst PositionDescription:StartDate:11/07/2016 EndDate: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

Noinformationtoreport

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Jan13,202016:38:32ESTAmer icanCol legeofPhysiciansPatriciaSiemion

SummaryofFinancialInterests

Idonothaveanyfinancialintereststodiscloseatthistime.

AdditionalInformation:

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizations

DisclosurePurpose:AnnualStaffDisclosure2019,AnnualStaffDisclosure2020

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement bet weenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Participationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Jan10,202009:33:04ESTAmer icanCol legeofPhysiciansFarahSultan

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

AmericanCollegeof Physicians Employment Self -

SigmaHeat hConsult ingLLC Other Self -

AdditionalInformation:

DisclosurePurpose:AnnualStaffDisclosure2019

Title:ResearchAssociate PositionDescription:Provideclinicalinputonevidencereviews,guidelines,performancemeasures,andhighvaluecaretopics.LeadScientificMedicalPolicyCommittee(SMPC),andsupporttheworkoftheSMPC,andother

StartDate:02/06/2016 EndDate: AdditionalInformation:

Category:Other ConsultantDescription:StartDate:05/16/2019 EndDate:12/16/2019 CompensationType:CashOtherCompensation: AnnualCompensation:AdditionalInformation:Part-timecontractposition(inactive)

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

None

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orce,AnnalsofInternalMedicineedit orialst af f orot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof anACPboard,commit t ee,council,chapt erleadership,t askf orceorot hergovernancegroupaspart of ACP’sannualgovernancedisclosureprocess?

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Jan18,202020:07:12ESTAmer icanCol legeofPhysiciansJenniferYost

SummaryofFinancialInterests

CompanyorOrganizat ion

Ent it y T ype Int erest HeldBy Value

CanadianInst it ut esof Healt hResearch Grant/Contract Self $9,310 ,000 .00

CanadianInst it ut esof Healt hResearch Grant/Contract Self $22,600 .00

CanadianInst it ut esof Healt hResearch Grant/Contract Self $226,000 .00

CanadianInst it ut esof Healt hResearch Grant/Contract Self $22,450 .00

EvidenceBasedResearchNetwork FiduciaryOfficer Self -

EvidenceSynt hesisInt ernat ional FiduciaryOfficer Self -

McMast erUniversit y Employment Self -

SigmaT het aT auInt ernat ional FiduciaryOfficer Self -

DisclosurePurpose:AnnualGovernanceDisclosure2020

RecipientName:Dr.MichaelMcGillion RecipientType:IndividualGrant/ContractDescription:TheSMArTVIEW,CoVeRed Grant/ContractPurpose:ResearchGrant/ContractAmount:$9,310 ,000 .00 Grant/ContractValuationDate:10 /15/2015ContractStartDate:10 /15/2015 ContractEndDate:09/30 /2019 AdditionalInformation:

RecipientName:Dr.SandraCarroll RecipientType:IndividualGrant/ContractDescription:FollowingtheC-SPINRoadmap:Realiz ingMeaningfulPatientEngagement

Grant/ContractPurpose:ResearchGrant/ContractAmount:$22,600 .00

Grant/ContractValuationDate:03/01/2016 ContractStartDate:03/01/2016 ContractEndDate:02/28/2018AdditionalInformation:

RecipientName:Dr.MichaelMcGillion RecipientType:IndividualGrant/ContractDescription:THESMArTVIEW,CoVeRed Grant/ContractPurpose:ResearchGrant/ContractAmount:$226,000 .00 Grant/ContractValuationDate:03/01/2016ContractStartDate:03/01/2016 ContractEndDate:02/28/2018 AdditionalInformation:

RecipientName:Dr.SandraCarroll RecipientType:IndividualGrant/ContractDescription:PrEPARE:PreparingforMeaningfulPatientEngagementatthePopulAtionHealthREsearch

Grant/ContractPurpose:ResearchGrant/ContractAmount:$22,450 .00

Grant/ContractValuationDate:03/01/2016 ContractStartDate:03/01/2016 ContractEndDate:02/28/2017AdditionalInformation:

OfficialTitle:SteeringCommitteeMember PositionDescription:CompensationType: OtherCompensation:StartDate:10 /01/2016 EndDate:AnnualCompensation:AdditionalInformation:

OfficialTitle:Secretariat PositionDescription:OrganizeandsupportactivitiesoftheorganisationCompensationType: OtherCompensation:StartDate:03/01/2018 EndDate:AnnualCompensation:AdditionalInformation:

Title:AssistantProfessor PositionDescription:StartDate:06/01/2010 EndDate:06/30 /2017 AdditionalInformation:

Universit yof Bologna Other Self $5,213.19

VillanovaUniversit y Employment Self -

AdditionalInformation:

OfficialTitle:President-AlphaNuChapter PositionDescription:President-AlphaNuChapterCompensationType: OtherCompensation:StartDate:09/01/2019 EndDate:08/31/2021AnnualCompensation:AdditionalInformation:

Category:Other ConsultantDescription:StartDate:11/16/2019 EndDate:11/22/2019 CompensationType:CashOtherCompensation: AnnualCompensation:

Year Amount T ype

2019 $5,213.19 Actual

AdditionalInformation:GuestLecturer

Title:AssociateProfessor PositionDescription:StartDate:08/22/2017 EndDate: AdditionalInformation:

1. Pleasespecif yanyaddit ionalinf ormat ionwhichyouconsiderrelevant t ot hisdisclosure.

N/A

2. ACPrequiresyourannualaf f irmat iont oabidebyit sDisclosureof Int erest sandManagement of Conf lict sPolicy,Non-DisclosureAgreement ,Int ellect ualPropert yPolicy,andAnt i-Harassment Policyifyou'resubmit t ingyourdisclosurest oACPasamemberof anACPgovernancegrouporasCollegest af f ,aspart of ACP'sannualdisclosureprocess.

a. Areyousubmit t ingyourdisclosurest oACPasamemberof oneof t hef ollowinggroups:ACPboard,commit t ee,council,t askf orce,and/orot hergovernancegroup?Chapt erCouncilorot herChapt erleadershiprole?Nat ionalorchapt erst af f ?Annalsof Int ernalMedicineedit orialst af f ?Other(meet ingguest s,cont ract ors,aut hors,et c.)

Yes.

i. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sDisclosureof Int erest sandManagement of Conf lict sPolicy.

Yes

ii. I,t heundersigned,ent erint ot heNon-DisclosureAgreement betweenmyself andt heAmericanCollegeof Physicians,whichgovernst hedisclosureandf urnishingof ACP'smembersof t heBoardof Regent s,Boardof Governors,Commit t ees,Councils,Governors-elect andChapt erPersonnelinanysuchWorkGroupof ACP,wit hinf ormat iondevelopedf orACP,deemed"Propriet aryInf ormat ion."

Yes

iii. I,t heundersigned,int endingt obelegallybound,herebydeclareandagreet ot ermsofpart icipat ionint heACPGroupact ivit iesof ACPasspecif iedint heACPInt ellect ualPropert yPolicy.

Yes

iv. I,t heundersigned,acknowledgeIhavereadandagreet oabidebyt heAmericanCollegeofPhysician’sAnt i-Harassment Policy.

Yes

Certification

Bysubmittingthisform,IattestthatIhavedisclosedallinterestsrelatedtohealthcarefromthelast3yearsonbehalfofmyselfandanyhouseholdmembers,includingconsiderationofinterestsinthefollowingareas:

Researchandconsultingsupport(e.g.,grants,contracts,sponsorships,honoraria,oranyotherfeesrelatedtoroleasconsultant,speaker’sbureauparticipation,orexpertaspartofregulatory,legislative,orjudicialprocess)Investmentsandproprietaryinterestsexcludingbroadlydiversifiedinvestmentssuchasmutualorpensionfunds(e.g.,stocks,bonds,stockoptions,commercialbusinessinterests,patents,trademarks,copyrights)Membershiponboards,workgroups,panels,orcommitteesthroughothermedicalsocietiesorhealthcareorganizationsParticipationinadvocacyorlobbyingactivities,includinganyrolesorrelationshipswithdiseaseadvocacyorganizations

Otheraspectsofmybackgroundorpresentinterestsnotaddressedabovethatmightbeperceivedasaffectingmyobjectivityorindependence