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Technology Champion COI Form

Technology Champion COI Form

All those requesting the acquisition of technologies that require review and approval by the UW Health Technology Assessment Committee must complete this disclosure report, indicating whether they have received payment from the manufacturer or marketer of the technology being requested. This form must be completed and returned to the Technology Assessment Program prior to consideration of the acquisition addition by the Technology Assessment Committee. The relationship between the requestor and the technology manufacturer/ marketer should be described in detail.