UK Template COMPANY NAME: YEAR: COUNTRY: DATE OF SUBMISSION TO CENTRAL PLATFORM: [insert date] METHODOLOGICAL NOTE (H) (Clause 24.10): [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: 28 June 2018 HCPs/ORDMs: City of Country of Principal Unique country local Fee for service and consultancy (Art. 3.01.1.c & 3.01.2.c & Clause Full Name Principal Practice HCOs: Principal Practice Address Contribution to costs of Events (Art. 3.01.1.b & 3.01.2.a & Clause 24) Blank Column (Clause X) Practice identifyer OPTIONAL 24) city where registered Donations and Grants to HCOs (Art. 3.01.1.a & Joint Working (Clause 20) TOTAL Clause 24) and Benefits in Kind to HCOs (Clause 24) Sponsorship agreements with Related expenses agreed in HCOs / third parties Blank Column Blank Column (Clause (Art. 1.01 & Clause 24) (Art. 3 & Clause 24) (Schedule 1 & Clause 24) (Art. 3 & Clause 24) (Art. 3 & Clause 24) Registration Fees Travel & Accommodation Fees the fee for service or appointed by HCOs to (Clause X) X) manage an Event consultancy 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) Dr Syed Abbas Harlow UK St Clare Hospice Harlow Hastingwood Road Hastingwood CM17 9JX N/A N/A N/A N/A £392.74 £392.74 Dr Ayesha Akbar London UK St Marks Hospital London Watford Road Harrow HA1 3UJ N/A N/A N/A N/A £172.56 £1,400.00 £1,572.56 Great Ormond Street Great Ormond Mr Jeremy Allgrove London UK London London WC1N 3JH N/A N/A N/A N/A £625.16 £475.96 £600.00 £1,075.96 Hospital Street Poole General Ms Sara Almeida Poole UK Poole Longfleet Road Poole BH15 2JB N/A N/A N/A N/A £215.00 £196.00 £411.00 Hospital Ms Susan Anderson Corby UK Lakelands Hospice Corby Butland Road Oakley Vale NN18 8LX N/A N/A N/A N/A £495.00 £495.00 Sheffield Children's Dr Paul Arundel Sheffield UK Sheffield Western Bank Sheffield S10 2TH N/A N/A N/A N/A £102.00 £102.00 Hospital Royal Liverpool and Dr Richard Azurdia Liverpool UK Broadgreen Liverpool Thomas Drive Liverpool L14 3LB N/A N/A N/A N/A £300.00 £300.00 University Hospitals Nurse Siobainn Bathgate Prescot UK Whiston Hospital Prescot Warrington Road Rainhill L35 5DR N/A N/A N/A N/A £54.00 £200.00 £254.00 Christie NHS 550 Wilmslow Dr Richard Berman Manchester UK Manchester Withington M20 4BX N/A N/A N/A N/A £462.28 £500.00 £962.28 Foundation Trust Road Royal Glamorgan Dr Raja Biswas Rhondda Cynon Taf UK Llantrisant Ynysmaerdy Talbot Green CF72 8XR N/A N/A N/A N/A £200.00 £200.00 Hospital Royal Cornwall Mr Christopher Blake Truro UK Truro Treliske Truro TR1 3LJ N/A N/A N/A N/A £1,031.06 £581.79 £1,612.85 Hospital Northwick Park & Nurse Adrian Brown Harrow UK Central Middlesex Harrow Watford Road Harrow HA1 3UJ N/A N/A N/A N/A £250.00 £200.85 £450.85 Hospitals Bristol Royal 24 Upper Maudlin Dr Christine Burren Bristol UK Bristol Bristol BS2 8BJ N/A N/A N/A N/A £549.90 £600.00 £1,149.90 Hospital for Children Street Glasgow Royal Mr Raphael Buttigieg Glasgow UK Glasgow McEwan Building, 16 Alexandra Parade, G31 2ER N/A N/A N/A N/A £267.00 £222.00 Infirmary Ms Mary Campbell Londonderry UK Altnagelvin Hospital Londonderry Western Trust Glenshane Road BT47 6SB N/A N/A N/A N/A £300.00 £300.00 Christie NHS Dr Anshuman Chaturvedi Manchester UK Manchester Wilmslow Road Manchester M20 4BX N/A N/A N/A N/A £250.00 £250.00 Foundation Trust Evelina London Westminster Bridge Dr Moira Cheung London UK London Guys & St Thomas SE1 7EH N/A N/A N/A N/A £334.50 £334.50 Children's Hospital Road 9th Floor, Regent Ms Helen Cochrane Stockport UK Steady in Stockport Stockport Heaton Lane SK4 1BS N/A N/A N/A N/A £100.00 £100.00 House Christie NHS Prof Richard Cowan Manchester UK Manchester Wilmslow Road Manchester M20 4BX N/A N/A N/A N/A £1,000.00 £1,000.00 Foundation Trust Ms Sally Cownie Bristol UK Southmead Hospital Bristol Southmead Road Bristol BS10 5NB N/A N/A N/A N/A £150.00 £166.00 £512.00 Basinghstoke & Ms Laura Coxden Basingstoke UK North Hampshire Basingstoke Aldermaston Road Basingstoke RG24 9NA N/A N/A N/A N/A £160.00 £160.00 Hospital Aintree University Ms Zoe Crook Liverpool UK Liverpool Elective Care Centre Longmoor Lane L9 7AL N/A N/A N/A N/A £50.00 £286.00 £336.00 Hospital Evelina London Westminster Bridge Nurse Robyn Cross London UK London Guys & St Thomas SE1 7EH N/A N/A N/A N/A £334.50 £334.50 Children's Hospital Road University College Dr John Cunningham London UK London 5 Devonshire Place London W1G 6HL N/A N/A N/A N/A £322.58 £322.58 London Royal Gwent Dr Marek Czajkowski Cardiff UK Newport Cardiff Road Newport NP20 2UB N/A N/A N/A N/A £250.00 £250.00 Hospital Velindre Cancer Mr James Davies Cardiff UK Cardiff Velindre Road Whitchurch CF14 2TL N/A N/A N/A N/A £392.74 £392.74 Centre Watford General Dr Senan Devendra Watford UK Watford Vicarage Road Watford WD18 0HB N/A N/A N/A N/A £400.00 £400.00 Hospital County Durham & Dr Anjan Dhar Bishop Auckland UK Darlington NHS Bishop Auckland Cockton Hill Road Bishop Auckland DL14 6AD N/A N/A N/A N/A £466.00 £466.00 Foundation Trust Alder Hey Children's Dr Poonam Dharmaraj Liverpool UK Liverpool Eaton Road Liverpool L12 2AP N/A N/A N/A N/A £1,047.37 £750.00 £1,797.37 Hospital Royal Victoria Queen Victoria Dr Chris Dipper Newcastle UK Newcastle Newcastle NE1 4LP N/A N/A N/A N/A £350.00 £350.00 Infirmary Road Dudley Group NHS Russell Hall Dr Shams Duja Dudley UK Dudley Pensnett Road DY1 2HQ N/A N/A N/A N/A £900.00 £213.50 £1,113.50 Foundation Trust Hospital Ms Irene Eastwood East Kilbride UK Hairmyres Hospital East Kilbride Eaglesham Road East Kilbride G75 8RG N/A N/A N/A N/A £34.00 £455.98 £489.98 Wythenshawe Dr Jane Edmonson Manchester UK Manchester Southmoor Road Wythenshawe M23 9LT N/A N/A N/A N/A £80.00 £80.00 Hospital Rtoyal Gwent Ms Maike Eylert Newport UK Newport Cardiff Road Newport NP20 2UB N/A N/A N/A N/A £295.00 £295.00 Hospital Royal Stoke Dr Adam Farmer Stoke on Trent UK Stoke on Trent Newcastle Road Stoke on Trent ST4 6QG N/A N/A N/A N/A £73.40 £1,000.00 £1,073.40 University Hospital Pennine Acute Ms Catherine Ferguson Manchester UK Manchester 3 Graham Street Beswick M11 3AA N/A N/A N/A N/A £330.25 £330.25 Hospitals NHS Trust Ms Siobhan Flanagan Downpatrick UK Downshire Hospital Downpatrick 53 Ardglass Rd Downpatrick BT30 6JQ N/A N/A N/A N/A £34.00 £432.99 £466.99 University Hospital, Clifford Bridge Dr Alison Franks Coventry UK Coventry Coventry CV2 2DX N/A N/A N/A N/A £50.40 £400.00 £450.40 Coventry Road Ms Margaret Frew Crosshouse UK Crosshouse Hospital Kilmarnock 30 Lister Road Crosshouse KA2 0BE N/A N/A N/A N/A £34.00 £436.98 £470.98 Stepping Hill Dr Yogalingham Ganeshwaran Stockport UK Stockport Poplar Grove Hazel Grove SK2 7JE N/A N/A N/A N/A £410.00 £274.00 £684.00 Hosptial University Hiospital Specialist Palliative Dr Kate Garbash Durham UK Durham North Road DH1 4RW N/A N/A N/A N/A £400.00 £400.00 of North Durham Care Team Royal Surrey County Nurse Anthony Gartland Guildford UK Guildford Egerton Road Guildford GU2 7XX N/A N/A N/A N/A £344.42 £250.00 £594.42 Hospital Royal Blackburn 12 Park View Ms Joanne Gaskell Blackburn UK Blackburn Haslingden Road BB2 3HH N/A N/A N/A N/A £495.00 £495.00 Hospital Offices Barts and The Royal Dr Evelien Gevers London UK London Whitechapel Road London EC1 1BB N/A N/A N/A N/A £543.88 £1,100.00 £1,643.88 London Hospital Ms Michelle Gilmore Armagh UK St Luke Hosptial Armagh Loughgall Road Armagh BT61 7NQ N/A N/A N/A N/A £34.00 £448.48 £482.48 Royal Liverpool Prof Ian Gilmore Liverpool UK Liverpool Foundation Building Brownlow Hill L69 7ZX N/A N/A N/A N/A £750.00 £325.25 £1,075.25 University Hospitals Ms Susan Glenn Belfast UK Mater Hospital Belfast Crumlin Road Belfast BT14 6AB N/A N/A N/A N/A £34.00 £480.98 £514.98 Royal Gwent Mr Vivek Goel Cardiff UK Cardiff Cardiff Road Newport NP20 2UP N/A N/A N/A N/A £400.00 £200.00 £600.00 Hospital Nottingham The Queen's Dr Arjun Gowda Nottingham UK University Hospital Nottingham Derby Road NG7 2UH N/A N/A N/A N/A £250.00 £250.00 Medical Centre NHS Trust The Prince Philip Dr Non Griffiths Llanelli UK Llanelli Bryngwyn Mawr Dafen SA14 8QF N/A N/A N/A N/A £35.00 £174.00 £209.00 Hospital Hywel Dda University Ms Julie Hamer Carmarthen UK Carmarthen St Davids Park Jobswell Road SA31 3BB N/A N/A N/A N/A £35.00 £160.00 £195.00 Health Board Department of Royal Liverpool Dr Fadil Mohammed Hannan Liverpool UK Liverpool Clinical Prescot Street L7 8XP N/A N/A N/A N/A £448.00 £448.00 University Hospital Biochemistry & Christie NHS Nurse Judith Harker Manchester UK Manchester Wilmslow Road Manchester M20 4BX N/A N/A N/A N/A £250.00 £250.00 Foundation Trust Musgrove Park Fracture Liaison Miss Gemma Hembery Taunton UK Taunton Parkfield Drive TA1 5DA N/A N/A N/A N/A £247.00 £253.00 £500.00 Hospital Service University of University of Prof Wolfgang Hogler Birmingham UK Birmingham Edgbaston B15 2TT N/A N/A N/A N/A £586.11 £434.00 £1,320.00 £2,340.11 Birmingham Birmingham Birmingham NHS Dr Andrew Holt Birmingham UK Birmingham 44E Nuffield House Birmingham B15 2TH N/A N/A N/A N/A £500.00 £500.00