Conflict of Interest Questionnaire for Directors and Officers
(Healthcare Organization)

Summary

This template is a questionnaire that may be used by a director or officer of a healthcare organization to identify his or her potential conflicts of interest. This template includes practical guidance and drafting notes. Healthcare organizations may require directors or officers to disclose any relationship that may pose a potential conflict of interest with that individual's role in the organization. Such individuals may be asked to complete this short conflict of interest questionnaire. For a full listing of key content for in-house counsel and corporate secretaries when performing corporate functions, see In-House Corporate Secretary Resource Kit. For more on healthcare generally, see First Year Associate Resource Kit: Healthcare, Healthcare Fundamentals Resource Kit, and Healthcare Fraud and Abuse Compliance Resource Kit. For a related conflict of interest policy, see Conflict of Interest Policy for Directors and Officers (Healthcare Organization). For a conflict of interest questionnaire and policy for other organization employees, see Conflict of Interest Questionnaire for Employees (Healthcare Organization) and Conflict of Interest Policy for Medical Staff (Healthcare Organization). For additional resources on building effective healthcare compliance plans, see Compliance Programs for Healthcare Providers, Healthcare Compliance Plan Elements, and Implementing a Healthcare Compliance Plan. To compare state and federal healthcare fraud and abuse laws, see the Healthcare State Law Comparison Tool.