For Guidelines writers and Taskforce Members

Thank you for being part of our BSH Guidelines.

Each BSH guideline follows a standard template which your writing group should use.

As a Writing Group or Taskforce Member, please fill in the relevant declaration of interest form below before you begin working on your guideline.

Please Note: Currently, the declaration of interest form is not available due to a system upgrade error. The issue is currently being worked on by our website team to correct this and we hope to resolve this shortly.

Declaration of Interest for Taskforce and Writing Group Members

If you are a BSH Guidelines Task Force member you must consider whether or not you have any interests that could conflict with your role. Conflicts of interest have to be declared when you are appointed and then every year.

All Writing Group members have to declare conflicts of interest before starting work on a guideline.

Data Protection Act 1998 – The information submitted will be held by the BSH for personnel or other reasons specified on this form and to comply with the BSH policies. This information may be held in both manual and computer form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000. For information on how your information is retained and processed, see our Processing Notice.

Personal Details

First Name *

Surname *

Email Address *

Contact Telephone Number *

Address (including postcode) *

Guidelines

Are you a member of the following:

BSH Guidelines Comittee
Haemato-Oncology Task Force
General Haematology Task Force
Transfusion Task Force
Haemostasis and Thrombosis Task Force

Are you a member of a writing group? *

Yes
No

I have read the BSH Guideline Process documentation (available at ) before commencing writing or involvement in the guideline. *

Declaration of Interests

Have you personally received any financial reimbursement from any drug / technology companies?

Yes
No

If you have received any financial reimbursement please state from which company (please list all if more than one) and also the name of the drug/technology (if appropriate). *

If you have received any financial reimbursement towards your department, please state from which company (please list all if more than one) and also the name of the Drug / technology (if appropriate). *

If the department you are employed by have received any financial reimbursement please state from which company (please list all if more than one) and also the name of the drug/technology (if appropriate). *

If any of your family members received any financial reimbursement please state from which company (please list all if more than one) and also the name of the drug/technology (if appropriate). *

Are the above interests specific to the product or services being evaluated for the named guideline topic? *

Yes
No

Other additional relevant information eg. membership with other organisations

Confirmation

I declare that the above details are correct to the best of my knowledge on *

Date of Declaration *

Expenses

If you incur expenses as part of the Guideline writing process, please read our expenses policy (.doc) before completing the expenses claim form (.doc).