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http://hrcak.srce.hr/medicina

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The Journal of Croatian Medical Association - Rijeka Branch and Faculty of Medicine - University of Rijeka

Authorship Agreement, Conflicts of Interest Disclosure Form and Copyright Transfer Form

http://hrcak.srce.hr/medicina

http://hlz-rijeka.com/medicina.html

Each author must read and sign the statements on: 1. Authorship Agreement, Criteria and Contributions 2. Conflicts of Interest Disclosure 3. Copyright Transfer

Manuscript Title: Authors: Corresponding Author: Date: Telephone: Fax: e-mail:

If necessary, photocopy this document to distribute to coauthors. This form is available online at http://hlz-rijeka.com/medicina.html.

This Agreement shall be governed by and construed in accordance with the laws of Croatia without regard to the principles of conflicts of law. The parties hereto submit to the non-exclusive jurisdiction of the Croatian courts.

http://hrcak.srce.hr/medicina

http://hlz-rijeka.com/medicina.html

The Journal of Croatian Medical Association - Rijeka Branch and Faculty of Medicine - University of Rijeka

1. AUTHORSHIP AGREEMENT, CRITERIA, AND CONTRIBUTIONS

Each author must read and sign a copy of this form. This form may be reproduced, but signed forms by all authors must be on file before the manuscript can appear in the journal. Each author should meet all criteria below. By signing this form, I agree that: · The manuscript represents original and valid work and that neither this manuscript nor one with substantially similar content under my authorship has been published previously or is being considered for publication elsewhere, except as described in an attachment, and copies of closely related manuscripts are provided · The Authors are the sole authors of and sole owners of the copyright in the manuscript. If the manuscript includes materials of others, the Authors have obtained the permission of the owners of the copyright in all such materials to enable them to grant the rights contained herein. Copies of all such permissions are attached to this licence · All of the facts contained in the manuscript are true and accurate · For papers with more than one author, I agreed to allow the corresponding author to serve as the primary correspondent with the Editorial office, to review the edited typescript and proof, and to make decisions regarding release of information in the manuscript to the media. If I am the only author, I will be the corresponding author and agree to serve in the roles described above · I have made substantial contributions to the intellectual content of the paper to qualify as an "author" under Medicina Fluminensis definition. I have participated suffi ciently in the research and analysis of data, as well as the writing of the manuscript, to take public responsibility for the work · I have given final approval of the version to be published · I am prepared to abide by the policies of this journal · If requested, I will provide the data or will cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the Editor or their assignees · Nothing in the manuscript is obscene, defamatory, libelous, violates any right of privacy or infringes any intellectual property rights (including without limitation copyright, patent or trademark) or any other human, personal or other rights of any person or entity or is otherwise unlawful. · Nothing in the manuscript infringes any duty of confidentiality which any of the Authors may owe to anyone else or violates any contract, express or implied, of any of the Authors, and all of the institutions in which work recorded in the Contribution was carried out have authorised publication of the Contribution.

AUTHORS (use more forms if needed to add names):

Name

Signature

Name Name Name Name

Signature Signature Signature Signature

http://hrcak.srce.hr/medicina

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The Journal of Croatian Medical Association - Rijeka Branch and Faculty of Medicine - University of Rijeka

2. CONFLICT OF INTEREST DISCLOSURE

The corresponding author must complete, execute, and submit this form to the Editorial Office on behalf of all the authors listed on the manuscript. For purposes of Medicina Fluminensis© and this disclosure form, a conflict of interest is a financial relationship or other set of circumstances that might affect, or might reasonably be thought by others to affect, an author's judgment, conduct or manuscript.

Please check the appropriate box (applies to the past 2 years and foreseeable future):

_____ I have no conflicts of interest, including specific financial interests and

relationships and affiliations relevant to the subject matter or materials discussed in the manuscript

_____ I certify that all my conflicts of interest, including specific financial interests and

relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are disclosed in the Acknowledgment section of the manuscript and in accordance with the requirements set by Medicina Fluminensis©.

I further understand that Medicina Fluminensis© reserves the right to decline to publish my work if the Journal believes that a significant conflict of interest exists.

Name of the Corresponding Author

Signature

http://hrcak.srce.hr/medicina

http://hlz-rijeka.com/medicina.html

The Journal of Croatian Medical Association - Rijeka Branch and Faculty of Medicine - University of Rijeka

3. ACKNOWLEDGMENT STATEMENT

Authors should obtain written permission from all individuals named in an Acknowledgment, since readers may infer their endorsement of data and conclusions. By signing this form I certify that · All persons who have made substantial contributions to the work reported in this manuscript (eg. data collection, analysis, or writing or editing assistance) but who do not fulfill the authorship criteria are named with their specific contributions in an Acknowledgment section in the manuscript All persons named in the Acknowledgment have provided me with written permission to be named If an Acknowledgment section is not included, no other persons have made substantial contributions to this manuscript.

· ·

Name of the Corresponding Author

Signature

http://hrcak.srce.hr/medicina

http://hlz-rijeka.com/medicina.html

The Journal of Croatian Medical Association - Rijeka Branch and Faculty of Medicine - University of Rijeka

4. COPYRIGHT TRANSFER

The purpose of this document is to transfer the full term of copyright in the above-named manuscript and all portions thereof (in written and electronic form) from the Author(s) to Croatian Medical Association ­ Rijeka Branch, the Publisher of Medicina Fluminensis©. Publisher's Obligation. The Publisher shall, upon determination of acceptability, publish a suitably edited and revised manuscript. The author(s) shall receive no royalty or other compensation for use of the material contained in the manuscript. Author's Consent to Publish. The undersigned corresponding author warrants the originality of the material in the above-named manuscript, that the copyright for the material has not been previously transferred, and that he or she has the authority to transfer the copyright on behalf of all co-authors. Each author, hereby assigns and transfers exclusively to the Publisher all of his or her rights in the material (in written and electronic form. Rights to Reproduction. Rights to reproduce all portions of the material from the published manuscript are granted exclusively to the Publisher. The CMA - Rijeka Branch and Faculty of Medicine - University of Rijeka have the exclusive licence to: · publish, reproduce, distribute, display and store the manuscript in all forms, formats and media whether now known or hereafter developed (including without limitation in print, digital and electronic form) throughout the world · to translate the manuscript into other languages, create adaptations, summaries or extracts of the manuscript or other derivative works based on the manuscript

Name of the Corresponding Author

Signature

Information

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