HIIQA Conflict of Interest Policy Statement

Individuals involved in decision making on behalf of the Health Improvement Institute Health Quality Award (HIIQA) may have other interests that can affect or be affected by their HIIQA-related decisions. This duality of interest can raise the potential for a conflict of interest when another interest comes into conflict with the Health Improvement Institute's interest in objective HIIQA assessments. All individuals serving on the HIIQA as an advisory board or volunteer assessment panel member are asked to question whether or not their affiliations, activities, interests and influences are compatible with their respective duties to the Health Improvement Institute, or could adversely affect their performance in assessing awards/ratings of Internet health information sites.

The Health Improvement Institute has established the following requirements designed to provide added assurance that situations raising potential conflicts of interests are identified and resolved:

I have reviewed the attached description of the HIIQA, including its purpose and awards/ratings selections and assessment procedures, and declare:
[ ] No conflict of interest
[ ] The following actual or potential conflicts of interest:

Further, I understand I will be asked to declare any actual or potential conflict of interest that I may have in relation to a particular award/ratings of Internet health information sites.

Signature: _________________________________________

Printed (word processed) name: __________________________

Date: _________________________________________