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A. Activity Involving Giving Educational Items and Gifts to a Healthcare Professional (HCP)

Annex A

B. Activity Involving Giving of Promotional Aids/Medical Utility to a HCP

Annex B

C. Gifts to Health Care Organizations (HCO)

Annex C

D. Giving Support/Sponsorship Directly to HCOs for their Seminars, Scientific Meetings and Third Party Conferences

Annex D

E. Giving Support/Sponsorship Directly to a HCP for Continuing Professional Development (Lectures, Seminars, Scientific Meetings, Symposia, Third Party Conferences, Conventions, Visits to Health Care Facilities with Technology Expertise)

Annex E

F. Activity Involving Medical Societies

Annex F

1. Activity Involving Giving Educational Items and Gifts to a Healthcare Professional (HCP)

1. This activity is not in exchange for the HCP’s prescription of the Company’s product.

Yes _____

No _____

1. The item to be given has a direct patient benefit or is related to the work of the HCP.

Yes _____

No _____

1. The item will not be given to any member of the HCP’s family.        

Yes _____

No _____

1. The value of the item is reasonable considering the patient benefit.

Yes _____

No _____

1. This activity will not include any form of entertainment that will entail costs.

Yes _____

No _____

1. This activity involves giving rebates or discounts to HCPs. [If the answer is “N/A”, skip item F.1. below.]

Yes _____

N/A _____

F.1. The rebate or discount will not be given to a doctor.

Yes _____

No _____

1. The recipient is not a government employee.

Yes _____

No ______

______________________________

Name

Designation

1. Activity Involving Giving of Promotional Aids/Medical Utility to a HCP

1. This activity is not in exchange for the HCP’s prescription of the Company’s product.

Yes _____

No _____

1. The item is either a promotional aid (i.e. non-monetary item given to an HCP for promotional purpose) or a medical utility (e.g. textbooks, subscriptions to medical journals or anatomical  models).

Yes _____

No _____

1. The item is a promotional aid (i.e., non-monetary item given to an HCP for promotional purpose). [If the answer is “N/A”, skip items C.1. and C.2. below.]

Yes _____

N/A _____

C.1. The item is relevant to the practice of the HCP’s profession or education of the patients.

Yes _____

No _____

C.2. The item serves a genuine promotional or educational value.

Yes _____

No _____

1. The item is a medical utility (e.g., textbooks, subscriptions to medical journals or anatomical models). [If the answer is “N/A”, skip item D.1. below.]

Yes _____

N/A _____

D.1. The item will benefit the patient or serve a genuine educational function for the HCP.

Yes _____

No _____

1. The value of the item is modest.

Yes _____

No _____

1. This activity will not include any form of entertainment that will entail costs.

Yes _____

No _____

1. The item does not have entertainment or recreational benefits.

Yes _____

No _____

1. The item is not a financial rebate to a doctor.

Yes _____

No _____