A.I. Burnasyan Scientific journal FMBC

Clinical Bulletin

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №3 2023 год

Conflict of interests disclosure form

The content of the declaration is in accordance with the ICMJE recommendations.

To fill out the declaration on the computer, click on the appropriate windows (in the browser!).

SECTION 1. Author

First Name Last Name Date

Are you a correspondent writer? Yes


If not, indicate the corresponding author

Article title


SECTION 2.Conflict of interest (in relation to the article)

Did you or your research organization receive financial support or services from a third party (government, commercial company, private foundation, or other research organization) in conducting the research and preparing the manuscript?

Yes No

If yes, please complete the fields below. Support options: grant, personal reward, non-financial support (provision of equipment, etc.) or other (explain in more detail),

Organization Name Support Form


SECTION 3.Conflicts of interest (in relation to the research topic)

During the last 3 years, have you participated in studies similar in content to the study described in the manuscript, and have you or your research organization received financial support for these studies? If the study described in the manuscript is on, for example, growth factor in lung cancer, please list studies on cancer in general. If the result of the study was the organization of the production of a product, you can not indicate the sources of grant funding, but be sure to indicate the manufacturing company in whose interests the product was developed.

Organization and form of support

Organization name


SECTION 4. Intellectual Property

Indicate patents and other intellectual property related to the research topic and their current status (application, valid patent, licensing, royalties).

Patent name Current status


SECTION 5.Other Conflicts of Interest

Do you have conflicts of interest that are not described elsewhere in the declaration?





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