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KKL UK Financial Declaration 2017 V2

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KKL UK Financial Declaration 2017 V2 UK Template COMPANY NAME:. YEAR: COUNTRY: DATE OF SUBMISSION TO CENTRAL PLATFORM: [insert date] METHODOLOGICAL NOTE (Clause X): [insert link here] DISCLOSURE OF PAYMENTS TO HEALTHCARE PROFESSIONALS (HCPs), OTHER RELEVANT DECISION MAKERS (ORDMs) AND HEALTHCARE ORGANISATIONS (HCOs) Article 2 - Section 2.03 & Schedule 2 & Clause 24 Date of publication: 10 July 2018 HCPs/ORDMs: City of Unique country local Full Name Principal Practice HCOs: city Country of Principal Practice Principal Practice Address Contribution to costs of Events (Art. 3.01.1.b & 3.01.2.a & Clause 24) Fee for service and consultancy (Art. 3.01.1.c & 3.01.2.c & Clause 24) Blank COlumn (Clause X) identifyer OPTIONAL where registered Donations and Grants to HCOs (Art. Joint Working (Clause 20) 3.01.1.a & Clause 24) TOTAL OPTIONAL and Benefits in Kind to HCOs (Clause 24) Sponsorship agreements with Related expenses agreed in the Blank COlumn (Clause Blank COlumn (Clause (Art. 1.01 & Clause 24) (Art. 3 & Clause 24) (Schedule 1 & Clause 24) (Art. 3 & Clause 24) (Art. 3 & Clause 24) HCOs / third parties appointed Registration Fees Travel & Accommodation Fees fee for service or consultancy X) X) by HCOs to manage an Event contract HCPs/ORDMs: City Of Principal Local Register ID Or Title First Name Initial Last Name Speciality Role Practice HCOs: city where Country Of Principal Practice InstitutiOn Name LocatiOn Address Line 1 Address Line 2 Post COde Email Third Party Database registered ID INDIVIDUAL NAMED DISCLOSURE - one line per HCP/ORDM (i.e. all transfers of value during a year for an individual HCP will be summed up: itemization should be available for the individual Recipient or public authorities' consultation only, as appropriate) Whipps CrOss Whipps CrOss Ms Shieny Abraham LondOn UK LondOn LeytOnstOne E11 1NR N/A N/A N/A N/A £100.00 £100.00 Hospital Road Royal HOspital fOr PrOf Faisal Ahmed GlasgOw UK GlasgOw Govan ROad GlasgOw C51 4TF N/A N/A N/A N/A £1,500.00 £79.99 £1,579.99 Sick Children Great OrmOnd Street Great OrmOnd Dr Jeremy AllgrOve LondOn UK LondOn LondOn WC1H 9JA N/A N/A N/A N/A £478.70 £1,880.00 £1,250.00 £259.80 £3,868.50 Hospital Street North Hampshire AldermastOn Dr Lara AllOway BasingstOke UK BasingstOke BasingstOke RG24 9NA N/A N/A N/A N/A £519.91 £633.40 £1,153.31 Hospital Road Wansbeck General Dr Satish Artham AshingtOn UK AshingtOn WoOdhOrn Lane AshingtOn NE63 9JJ N/A N/A N/A N/A £199.97 £300.03 £500.00 Hospital Sheffield Childrens Dr Paul Arundel Sheffield UK Sheffield Western Bank Sheffield S10 2TH N/A N/A N/A N/A £1,250.00 £21.98 £1,250.00 Hospital Dr Benjamin Ayres LondOn UK St GeOrges HOspital LondOn Blackshaw ROad ToOting SW17 0QT N/A N/A N/A N/A £622.05 £597.00 £1,219.05 Western General Ms Lucy Baird Edinburgh UK Edinburgh Crewe ROad Edinburgh EH4 2XU N/A N/A N/A N/A £495.00 £495.00 Hospital Aberdeen ROyal Dr Snehashish Banik Aberdeen UK Aberdeen Foresterhill Aberdeen AB25 2ZN N/A N/A N/A N/A £335.00 £402.98 £737.98 Infirmary Christie NHS Dr Richard Berman Manchester UK Manchester WilmslOw ROad WithingtOn M20 4BX N/A N/A N/A N/A £310.02 £2,327.96 £2,000.00 £50.40 £4,688.38 FoundatiOn Trust Ms Clare Bird Newcastle UK Freeman HOspital Newcastle Freeman ROad High HeatOn NE7 7DN N/A N/A N/A N/A £313.07 £702.93 £1,016.00 Royal VictOria 274 GrOsvenOr Dr Ryan Boyle Belfast UK Belfast Belfast BT126BA N/A N/A N/A N/A £405.00 £405.00 Hospital Road Northwick Park Mr Adrian BrOwn HarrOw UK HarrOw WatfOrd ROad HarrOw HA1 3UJ N/A N/A N/A N/A £250.00 £35.00 £285.00 Hospital Wirral University Dr Mark Buchanan UptOn UK UptOn ArrOwe Park ROad UptOn CH49 5PE N/A N/A N/A N/A £405.00 £304.50 £709.50 Teaching HOspital Westbury-On- Miss Helena Burden BristOl UK Southmead HOspital BristOl Southmead ROad BS10 5NB N/A N/A N/A N/A £350.00 £350.00 Trym Belfast City Dr Laurence Burke Belfast UK Belfast Trust Belfast Lisburn Rd BT9 7AB N/A N/A N/A N/A £405.00 £366.98 £771.98 Hospital BristOl ROyal Upper Maudlin Dr Christine Burren BristOl UK BristOl BristOl BS2 8BJ N/A N/A N/A N/A £1,250.00 £99.20 £1,349.20 Hospital fOr Children Street Ms Mary Campbell LondOnderry UK Altnagelvin HOspital LondOnderry Western Trust Glenshane ROad BT47 8PN N/A N/A N/A N/A £427.19 £427.19 Ayr University DalmellingtOn Miss Ashley Carrera Ayr UK Ayr Ayr KA66 6DX N/A N/A N/A N/A £500.00 £500.00 Hospital Road Marie Curie HOspice Dr Laura Chapman LiverpOOl UK LiverpOOl Speke ROad WoOltOn L25 8QA N/A N/A N/A N/A £515.91 £653.22 £1,169.23 LiverpOOl West Middlesex Twickenham Mr KonstantinOs CharitOpOulOs LondOn UK LondOn LondOn TW7 6AF N/A N/A N/A N/A £200.00 £200.00 University HOspital Road Evelina LOndOn St ThOmas Westminster Dr Moira Cheung LondOn UK LondOn SE1 7EH N/A N/A N/A N/A £1,250.00 £167.50 £1,417.50 Childrens HOspital Hospital Bridge ROad University HOspital Mr Karyee ChOw Manchester UK Manchester SouthmOOr ROad Wythenshawe M23 9LT N/A N/A N/A N/A £927.00 £927.00 South Manchester Doncaster ROyal Nurse Sonia Clark Doncaster UK Doncaster ThrOne ROad Doncaster DN2 5LT N/A N/A N/A N/A £100.00 £100.00 Infrimary Doncaster ROyal Sister Sonia Clarke Doncaster UK Doncaster ThOrne ROad Doncaster DN2 5LT N/A N/A N/A N/A £405.00 £332.30 £737.30 Infirmary James COOk Ms NicOla CoOper MiddlesbrOugh UK MiddlesbrOugh MartOn ROad MiddlesbrOugh TS34 4BW N/A N/A N/A N/A £339.90 £339.90 University Dr Bernie CorcOran Belfast UK Belfast City HOspital Belfast Lisburn ROad Belfast BT8 7AB N/A N/A N/A N/A £250.00 £250.00 Dr Adam Cox Swansea UK MorristOn HOspital Swansea HeOl Maes Eglwys MorristOn SA6 6NL N/A N/A N/A N/A £280.00 £520.00 £800.00 South Tees NHS Dr Joanne Cresswell MiddlesbrOugh UK FoundatiOn HOspitals MiddlesbrOugh MartOn ROad MiddlesbrOugh TS4 3BW N/A N/A N/A N/A £622.05 £796.00 £1,418.05 Trust University HOspital Dr Dev Datta Penarth UK Penarth Penlan ROad Penarth CF62 2XX N/A N/A N/A N/A £900.00 £12.70 £912.70 LlandOugh GeOrge ThOmas Whitchurch Dr James Davies Cardiff UK Cardiff Park ROad CF14 7BF N/A N/A N/A N/A £276.44 £276.44 Hospice Hospital GrOunds Shrewsbury & Dr K Dhinakaran Shrewsbury UK TelfOrd HOspital NHS Shrewsbury MyttOn Oak RaOd Shrewsbury SY3 8XQ N/A N/A N/A N/A £150.00 £150.00 Trust Mrs ShOna DicksOn Dundee UK Ninewells HOspital Dundee Ninewells Dundee DD1 9SY N/A N/A N/A N/A £515.91 £786.63 £1,302.54 Royal VictOria Queen VictOria Dr Christian Dipper Newcastle UK Newcastle Newcastle NE1 4LP N/A N/A N/A N/A £500.00 £500.00 Infirmary Road Russells Hall Dr Shams Duja Dudley UK Dudley Pensett ROad Dudley DY1 2HQ N/A N/A N/A N/A £500.00 £500.00 Hospital Dr AlisOn Duncan NewpOrt UK St Anne's HOspice NewpOrt Harding Avenue NewpOrt NP20 6ZE N/A N/A N/A N/A £500.00 £500.00 Mr Jamie Dunn Torquay UK Torbay HOspital Torquay Lowes Bridge Torquay TQ2 7AA N/A N/A N/A N/A £350.00 £350.00 East Kent HOspitals Dr Ben Eddy Canterbury UK University NHS Canterbury Ethelbert ROad Canterbury CT1 3NG N/A N/A N/A N/A £622.05 £498.40 £1,120.45 FoundatiOn Trust Aintree University Dr MahmOud Elfar LiverpOOl UK LiverpOOl LongmOOr Lane LiverpOOl L9 7AL N/A N/A N/A N/A £622.05 £1,120.00 £1,742.05 Hospital University COllege Dr AntOn Emmanuel LondOn UK LondOn 235 EustOn ROad LondOn NW1 2BU N/A N/A N/A N/A £1,000.00 £1,000.00 Hospital Doncaster & Dr Justin FernandO Doncaster UK Doncaster ArmthOrpe ROad Doncaster DN2 5LT N/A N/A N/A N/A £515.91 £700.87 £1,216.78 Bassetlaw HOspital University CliffOrd Bridge Dr AlisOn Franks Coventry UK Arden Cancer Centre Coventry Hospital COventry CV2 2DX N/A N/A N/A N/A £250.00 £380.99 #REF! Road & Warwickshire University HOspitals CliffOrd Bridge Dr AlisOn Franks Coventry UK Coventry Coventry CV2 2DX N/A N/A N/A N/A £400.00 £400.00 Coventry & Warwick Road Westbury-On- Ms Amanda Fuller BristOl UK Southmead HOspital BristOl Southmead ROad BS10 5NB N/A N/A N/A N/A £265.00 £265.00 Trym St David's COurt 68a COwbridge Dr Amir GhanghrO CantOn UK CantOn CantOn CF11 9DU N/A N/A N/A N/A £250.00 £250.00 Surgery Road East Royal Gwent Dr Vivek Goel NewpOrt UK NewpOrt Cardiff ROad NewpOrt NP20 2UB N/A N/A N/A N/A £350.00 £350.00 Hospital Dorset COunty Nurse Andrew Goffe Dorchester UK Dorchester Williams Avenue Dorchester DT1 2JY N/A N/A N/A N/A £300.00 £189.74 £489.74 Hospital Wansbeck General Ms NicOla Graham AshingtOn UK AshingtOn WoOdhOrn Lane AshingtOn NE63 9JJ N/A N/A N/A N/A £210.00 £165.00 £375.00 Hospital Barts Health NHS Whitechapel Ms Evelien Grevers LondOn UK LondOn Whitechapel E1 1BB N/A N/A N/A N/A £760.00 £760.00 Trust Road University HOspitals PrOf LeyshOn Griffiths Leicester UK of Leicester NHS Leicester GwendOlen ROad Leicester LE5 4PW N/A N/A N/A N/A £622.05 £954.50 £1,150.00 £50.20 £2,776.75 Trust West Middlesex Twickenham Ms Nimrata Gujral IslewOrth UK IslewOrth IslewOrth TW7 6AF N/A N/A N/A N/A £130.00 £130.00 University HOspital Road Glangwili General Dr Abhaya Gupta Glangwili UK Glangwili Dolgwili ROad Glangwili SA31 2AF N/A N/A N/A N/A £400.00 £400.00 Hospital AddenbrOOkes EndOcrine Ms Julia Hale Cambridge UK Cambridge Hills ROad CB2 0QQ N/A N/A N/A N/A £360.00 £360.00 Hospital InvestigatiOn Unit Royal United Ms Elizabeth HancOck Bath UK Bath Combe Park Bath BA1 3NG N/A N/A N/A N/A £265.00 £265.00 Hospital Doncaster ROyal Dr Madhubrata Hazra Doncaster UK Doncaster ArmthOrpe ROad Doncaster DN2 5LT N/A N/A N/A N/A £350.00 £350.00 Infirmary Mr Rakesh Heer Newcastle UK Freeman HOspital Newcastle Freeman ROad High HeatOn NE7 7DN N/A N/A N/A N/A £600.00 £123.90 £723.90 Royal United Mrs Ros Helps Bath UK Bath Combe Park Bath BA1 3NG N/A N/A N/A N/A £265.00 £265.00 Hospital University COllege Dr NichOlas HerOdOtOu LondOn UK LondOn Medical LondOn Gower Street
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