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What is the form name?

OCR text of the page · 1,956 characters; the scanned image itself is not published
KICMJE
INTERNATIONAL COMMITTEE
MEDICAL JOURNAL EDITORS
ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 1.
1. Given Name (First Name)
2. Surname (Last Name)
3. Date
Michael
Dourson
01-August-2016
4. Are you the corresponding author?
Yes NG
Corresponding Author's Name
Patricia Nance
5. Manuscript Title
Update: Mode of Action (MOA) for Liver Tumors Induced by
Oral Exposure to 1,4-Dioxane
6. Manuscript Identifying Number (if you know it)
Section >
The Work Under Consideration for Put
Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for
any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,
statistical analysis, etc.)?
Are there any relevant conflicts of interest? Yes []No
If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row.
Excess rows can be removed by pressing the "X" button.
Name of Institution/Company
Grant
Personal | Non-Financial
other
comments
Fees
Support
Hamp, Mathews & Associates, Inc.
PPG Corporation
Waste Management
0OO
Financial Support via Contract
Financial Support via Contract
Financial Support via Contract
Section 3.
Relevant to
Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amount
of compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need by
clicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Are there any relevant conflicts of interest? Yes [ No
Section 4.
Intellectual Property
Do you have any patents, whether planned, pending or issued, broadly relevant to the work? []Yes [] No
Dourson
2
Source: https://www.industrydocuments.ucsf.edu/docs/Izbn0226
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Expected answer
ICMJE form for disclosure of potential conflicts of interest
Models
4 of 4 columns · click a model to add or remove it

Ours

Exact match

ICMJE Form for Disclosure of Potential Conflicts of Interest

60 characters13 tokens

Aux 2015

Wrong

KICMJE

6 characters5 tokens

PiT-FT 2015

Wrong

Empty response.

0 characters

ChronoGPT 2015

Wrong

Question:

What is the form name of the following document?

KICMJE INTERNATIONAL COMMITTEE MEDICAL JOURNAL EDITORS ICMJE Form for Disclosure of Potential Conflicts of Interest Section 1.

  1. Given Name (
207 characters64 tokens