The Organization has adopted a Conflict of Interest policy for its staff and contractors. A copy of that Policy is available upon request. As described more fully in the Policy, the Policy requires disclosure of potential conflicts of interest, including speaker’s bureau relationships, advisory board participation, consulting, patent applications, non-Organization practice-related research, and arrangements with non-public companies such as board membership, ownership, and options or rights to become an owner, as well as relationships with organizations that may result in referrals to this Organization. The Organization also monitors the CMS Open Payments Database for potential conflicts of interest with practitioners.
 
Please complete the form below, and a member of the Compliance Department will reach out to you to help you properly manage any potential conflicts of interest. You may also request a copy of this form in paper-version from your local Compliance designee. YOU MUST SELECT "YES" FOR FURTHER DISCUSSING THE ISSUE IN ORDER FOR YOU TO ENTER YOUR CONTACT INFORMATION.

If you wish to report a concern about another staff member or vendor's potential conflict of interest, not your own, please CLICK HERE to submit a Compliance Hotline report. 

Please note: some of this portal is not customizable, thus, certain fields may be worded atypically. Please consider the following:

• "Date observed or first noticed" is for the date you identify a potential conflict of interest
• "Location of Incident" is the Vivant locality where you are primarily employed/contracted
• "Description of Events or Concerns" is where you can provide a detailed explanation of your potential conflict of interest, including, for example, your time commitment, amount of compensation for serving on an advisory board or as a consultant, which family member(s) is/are involved in the potential conflict, etc.