Annual Disclosure of Outside Interest and Activities Questionnaire

Medical Center employees have received an email requesting completion of an Annual Disclosure of Outside Interest and Activities Questionnaire. This request is in accordance with the GR Medical Center Conflict of Interest Policy which requires that all employees disclose any actual or potential conflicts of interest. The Office of Compliance and Risk Management has employed a web-based program called COI-SMART ( to collect, store, and manage the disclosures.

When initially signing onto the system, employees may receive the following message:

The Service Provider being authenticated has requested account federation with this site.Service Provider domain: you give consent for this federation?

Give consent for this federation. Upon logging into the system, read each question and submit your answer. If you need further explanation of any question you may save your questionnaire, call Compliance and Enterprise Risk Management, or refer to the policy for reference and then proceed with the questionnaire.

The deadline for submission of this questionnaire will be extended to accommodate the recent addition of GR Medical Center staff. The deadline is September 30, 2015.


Office of Compliance and Enterprise Risk Management


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