ICMJE Form for Disclosure of Potential Conflicts of Interest
Instructions
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.

1.

Identifying information.

2.

The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of thework itself, from the initial conception and planning to the present. The requested information is about resources that you received,
either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the workwithout receiving any financial support from any third party -- that is, the work was supported by funds from the same institution thatpays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds
from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check"Yes".

3.

Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or thatgive the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entitythat could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor(EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer
in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to
submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from theentity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work
should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could beperceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could beperceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or
academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved
and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.

4.

Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.

5.

Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work.

Definitions.
Entity: government agency, foundation, commercial sponsor,
academic institution, etc.
Grant: A grant from an entity, generally [but not always] paid to yourorganization
Personal Fees: Monies paid to you for services rendered, generally
honoraria, royalties, or fees for consulting , lectures, speakers bureaus,
expert testimony, employment, or other affiliations
Non-Financial Support: Examples include drugs/equipment
supplied by the entity, travel paid by the entity, writing assistance,
administrative support, etc.

Rackauskaite

Other: Anything not covered under the previous three boxes
Pending: The patent has been filed but not issued
Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether
earning royalties or not
Royalties: Funds are coming in to you or your institution due to yourpatent1

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 1.

Identifying Information

1. Given Name (First Name)

2. Surname (Last Name)

3. DateGija

Rackauskaite

01-April-2015

4. Are you the corresponding author?

✔ Yes

No

5. Manuscript Title

Regional differences in management of cerebral palsy in Denmark: a national survey
6. Manuscript Identifying Number (if you know it)

Section 2.

The Work Under Consideration for Publication

Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for
any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,
statistical analysis, etc.)?
✔ Yes

Are there any relevant conflicts of interest?

No

If yes, please fill out the appropriate information below. If you have more than one entity press the "ADD" button to add a row.
Excess rows can be removed by pressing the "X" button.
Name of Institution/Company

Grant? Personal Non-Financial Other
Fees?
Support?

? Comments

Augustinus Fund✔

Bevica Fund✔

Dagmar Marshalls Fund✔

Ludvig and Sara Elsass Fund✔

Civil Engineer Frode V. Nyegaard’s and His
Wife’s Fund✔

Clinical Institute at Aarhus University Hospital✔

Research Council at the Central Denmark
Region✔

Section 3.

Relevant financial activities outside the submitted work.

Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amountof compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need byclicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Are there any relevant conflicts of interest?

Rackauskaite

Yes

✔ No

2

ICMJE Form for Disclosure of Potential Conflicts of Interest

Section 4.

Intellectual Property -- Patents & Copyrights

Do you have any patents, whether planned, pending or issued, broadly relevant to the work?

Section 5.

Yes

✔ No

Relationships not covered above

Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work?
✔ Yes, the following relationships/conditions/circumstances are present (explain below):

No other relationships/conditions/circumstances that present a potential conflict of interest
was emploied pat-time as paediatrician in two hospitals in Central Denmark Region during study period.

At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements.
On occasion, journals may ask authors to disclose further information about reported relationships.

Section 6.

Disclosure Statement

Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box
below.

Dr. Rackauskaite reports grants from Augustinus Fund, grants from Bevica Fund, grants from Dagmar Marshalls Fund, grants
from Ludvig and Sara Elsass Fund, grants from Civil Engineer Frode V. Nyegaard’s and His Wife’s Fund, grants from ClinicalInstitute at Aarhus University Hospital, grants from Research Council at the Central Denmark Region, during the conduct of
the study; and was emploied pat-time as paediatrician in two hospitals in Central Denmark Region during study period..

Rackauskaite

3

ICMJE Form for Disclosure of Potential Conflicts of Interest
Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.

Rackauskaite

4

ICMJE Form for Disclosure of Potential Conflicts of Interest
Instructions
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.

1.

Identifying information.

2.

The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of thework itself, from the initial conception and planning to the present. The requested information is about resources that you received,
either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the workwithout receiving any financial support from any third party -- that is, the work was supported by funds from the same institution thatpays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds
from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check"Yes".

3.

Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or thatgive the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entitythat could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor(EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer
in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to
submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from theentity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work
should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could beperceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could beperceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or
academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved
and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.

4.

Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.

5.

Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work.

Definitions.
Entity: government agency, foundation, commercial sponsor,
academic institution, etc.
Grant: A grant from an entity, generally [but not always] paid to yourorganization
Personal Fees: Monies paid to you for services rendered, generally
honoraria, royalties, or fees for consulting , lectures, speakers bureaus,
expert testimony, employment, or other affiliations
Non-Financial Support: Examples include drugs/equipment
supplied by the entity, travel paid by the entity, writing assistance,
administrative support, etc.

Ostergaard

Other: Anything not covered under the previous three boxes
Pending: The patent has been filed but not issued
Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether
earning royalties or not
Royalties: Funds are coming in to you or your institution due to yourpatent1

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 1.

Identifying Information

1. Given Name (First Name)

2. Surname (Last Name)

3. DateJohn

Ostergaard

04-April-2015

4. Are you the corresponding author?

✔ No

Yes

Corresponding Author’s Name

Gija Rackauskaite
5. Manuscript Title

Regional differences in management of cerebral palsy in Denmark: a national survey
6. Manuscript Identifying Number (if you know it)

Section 2.

The Work Under Consideration for Publication

Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for
any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,
statistical analysis, etc.)?

Are there any relevant conflicts of interest?

Section 3.

Yes

✔ No

Relevant financial activities outside the submitted work.

Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amountof compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need byclicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Are there any relevant conflicts of interest?

Section 4.

Yes

✔ No

Intellectual Property -- Patents & Copyrights

Do you have any patents, whether planned, pending or issued, broadly relevant to the work?

Ostergaard

Yes

✔ No

2

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 5.

Relationships not covered above

Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):✔ No other relationships/conditions/circumstances that present a potential conflict of interest

At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements.
On occasion, journals may ask authors to disclose further information about reported relationships.

Section 6.

Disclosure Statement

Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box
below.

Dr. Ostergaard has nothing to disclose.

Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.

Ostergaard

3

ICMJE Form for Disclosure of Potential Conflicts of Interest
Instructions
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.

1.

Identifying information.

2.

The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of thework itself, from the initial conception and planning to the present. The requested information is about resources that you received,
either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the workwithout receiving any financial support from any third party -- that is, the work was supported by funds from the same institution thatpays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds
from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check"Yes".

3.

Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or thatgive the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entitythat could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor(EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer
in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to
submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from theentity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work
should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could beperceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could beperceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or
academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved
and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.

4.

Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.

5.

Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work.

Definitions.
Entity: government agency, foundation, commercial sponsor,
academic institution, etc.
Grant: A grant from an entity, generally [but not always] paid to yourorganization
Personal Fees: Monies paid to you for services rendered, generally
honoraria, royalties, or fees for consulting , lectures, speakers bureaus,
expert testimony, employment, or other affiliations
Non-Financial Support: Examples include drugs/equipment
supplied by the entity, travel paid by the entity, writing assistance,
administrative support, etc.

Hammer Bech

Other: Anything not covered under the previous three boxes
Pending: The patent has been filed but not issued
Issued: The patent has been issued by the agency
Licensed:




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Funds are coming in to you or your institution due to yourpatent1

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 1.

Identifying Information

1. Given Name (First Name)

2. Surname (Last Name)

3. Date

Bodil

Hammer Bech

17-April-2015

4. Are you the corresponding author?

✔ No

Yes

Corresponding Author’s Name

Gija Rackauskaite
5. Manuscript Title

Regional differences in management of cerebral palsy in Denmark: a national survey
6. Manuscript Identifying Number (if you know it)

Section 2.

The Work Under Consideration for Publication

Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for
any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,
statistical analysis, etc.)?

Are there any relevant conflicts of interest?

Section 3.

Yes

✔ No

Relevant financial activities outside the submitted work.

Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amountof compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need byclicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Are there any relevant conflicts of interest?

Section 4.

Yes

✔ No

Intellectual Property -- Patents & Copyrights

Do you have any patents, whether planned, pending or issued, broadly relevant to the work?

Hammer Bech

Yes

✔ No

2

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 5.

Relationships not covered above

Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):✔ No other relationships/conditions/circumstances that present a potential conflict of interest

At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements.
On occasion, journals may ask authors to disclose further information about reported relationships.

Section 6.

Disclosure Statement

Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box
below.

Dr. Hammer Bech has nothing to disclose.

Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.

Hammer Bech

3

ICMJE Form for Disclosure of Potential Conflicts of Interest
Instructions
The purpose of this form is to provide readers of your manuscript with information about your other interests that could
influence how they receive and understand your work. The form is designed to be completed electronically and stored
electronically. It contains programming that allows appropriate data display. Each author should submit a separate
form and is responsible for the accuracy and completeness of the submitted information. The form is in six parts.

1.

Identifying information.

2.

The work under consideration for publication.
This section asks for information about the work that you have submitted for publication. The time frame for this reporting is that of thework itself, from the initial conception and planning to the present. The requested information is about resources that you received,
either directly or indirectly (via your institution), to enable you to complete the work. Checking "No" means that you did the workwithout receiving any financial support from any third party -- that is, the work was supported by funds from the same institution thatpays your salary and that institution did not receive third-party funds with which to pay you. If you or your institution received funds
from a third party to support the work, such as a government granting agency, charitable foundation or commercial sponsor, check"Yes".

3.

Relevant financial activities outside the submitted work.
This section asks about your financial relationships with entities in the bio-medical arena that could be perceived to influence, or thatgive the appearance of potentially influencing, what you wrote in the submitted work. You should disclose interactions with ANY entitythat could be considered broadly relevant to the work. For example, if your article is about testing an epidermal growth factor receptor(EGFR) antagonist in lung cancer, you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer
in general, not just in the area of EGFR or lung cancer.
Report all sources of revenue paid (or promised to be paid) directly to you or your institution on your behalf over the 36 months prior to
submission of the work. This should include all monies from sources with relevance to the submitted work, not just monies from theentity that sponsored the research. Please note that your interactions with the work's sponsor that are outside the submitted work
should also be listed here. If there is any question, it is usually better to disclose a relationship than not to do so.
For grants you have received for work outside the submitted work, you should disclose support ONLY from entities that could beperceived to be affected financially by the published work, such as drug companies, or foundations supported by entities that could beperceived to have a financial stake in the outcome. Public funding sources, such as government agencies, charitable foundations or
academic institutions, need not be disclosed. For example, if a government agency sponsored a study in which you have been involved
and drugs were provided by a pharmaceutical company, you need only list the pharmaceutical company.

4.

Intellectual Property.
This section asks about patents and copyrights, whether pending, issued, licensed and/or receiving royalties.

5.

Relationships not covered above.
Use this section to report other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work.

Definitions.
Entity: government agency, foundation, commercial sponsor,
academic institution, etc.
Grant: A grant from an entity, generally [but not always] paid to yourorganization
Personal Fees: Monies paid to you for services rendered, generally
honoraria, royalties, or fees for consulting , lectures, speakers bureaus,
expert testimony, employment, or other affiliations
Non-Financial Support: Examples include drugs/equipment
supplied by the entity, travel paid by the entity, writing assistance,
administrative support, etc.

UldallOther: Anything not covered under the previous three boxes
Pending: The patent has been filed but not issued
Issued: The patent has been issued by the agency
Licensed: The patent has been licensed to an entity, whether
earning royalties or not
Royalties: Funds are coming in to you or your institution due to yourpatent1

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 1.

Identifying Information

1. Given Name (First Name)

2. Surname (Last Name)

3. Datepeter vilhelm

Uldall

01-July-2015

4. Are you the corresponding author?

✔ No

Yes

Corresponding Author’s Name

Gija Rackauskaite
5. Manuscript Title

Regional differences in management of cerebral palsy in Denmark: a national survey
6. Manuscript Identifying Number (if you know it)

Section 2.

The Work Under Consideration for Publication

Did you or your institution at any time receive payment or services from a third party (government, commercial, private foundation, etc.) for
any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation,
statistical analysis, etc.)?

Are there any relevant conflicts of interest?

Section 3.

Yes

✔ No

Relevant financial activities outside the submitted work.

Place a check in the appropriate boxes in the table to indicate whether you have financial relationships (regardless of amountof compensation) with entities as described in the instructions. Use one line for each entity; add as many lines as you need byclicking the "Add +" box. You should report relationships that were present during the 36 months prior to publication.
Are there any relevant conflicts of interest?

Section 4.

Yes

✔ No

Intellectual Property -- Patents & Copyrights

Do you have any patents, whether planned, pending or issued, broadly relevant to the work?

Uldall

Yes

✔ No

2

ICMJE Form for Disclosure of Potential Conflicts of Interest
Section 5.

Relationships not covered above

Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance ofpotentially influencing, what you wrote in the submitted work?
Yes, the following relationships/conditions/circumstances are present (explain below):✔ No other relationships/conditions/circumstances that present a potential conflict of interest

At the time of manuscript acceptance, journals will ask authors to confirm and, if necessary, update their disclosure statements.
On occasion, journals may ask authors to disclose further information about reported relationships.

Section 6.

Disclosure Statement

Based on the above disclosures, this form will automatically generate a disclosure statement, which will appear in the box
below.

Dr. Uldall has nothing to disclose.

Evaluation and Feedback
Please visit http://www.icmje.org/cgi-bin/feedback to provide feedback on your experience with completing this form.

Uldall3