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: ………………………………………………….. HCPs/ORDMs: City of Unique country Country of Principal Fee for service and consultancy (Art. 3.01.1.c & 3.01.2.c & Full Name Principal Practice HCOs: Principal Practice Address local identifier Contribution to costs of Events (Art. 3.01.1.b & 3.01.2.a & Clause 24) Blank Column (Clause X) Practice Clause 24) city where registered OPTIONAL Donations and Grants to HCOs (Art. 3.01.1.a & Joint Working (Clause 20) Clause 24) and TOTAL Benefits in Kind to HCOs (Clause Sponsorship agreements 24) Related expenses agreed with HCOs / third parties Blank Column Blank Column (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 in the fee for service or appointed by HCOs to (Clause X) (Clause X) manage an Event consultancy contract HCPs/ORDMs: City of Local Register ID or Country of Principal Title First Name Initial Last Name Speciality Role Principal Practice HCOs: Institution Name Location Address Line 1 Address Line 2 Post Code Email Third Party Database Practice city where 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 Christopher Kobylecki Manchester United Kingdom Salford Royal Salford Royal Salford M6 8HD 1500 22,95 1522,95 Ms Patsy Cotton Manchester United Kingdom Salford Royal Salford Royal Salford M6 8HD 300 300 Dr Omesh Kulkarni Preston United Kingdom Dept Neurology, Preston Hospital Sharoe Green Lancashire PR2 9HT 518,64 933,54 200 1652,18 Ms Alison Leake London United Kingdom St Georges Hospital, Tooting London London SW17 0QT 1300 130,66 1430,66 Dr Abhjit Chaudhuri Essex United Kingdom Queens Hospital Rom Valley Way, Essex RM7 0AG 750 750 Prof Matthias Koepp London United Kingdom National Hospital for Neurology & Queens Square London WC1N 3BG 1650 1650 Dr Jean Paul Taylor Newcastle United Kingdom Newcastle University 3rd Floor Newcastle NE4 5PL 1000 105,8 1105,8 Ms Sue Thomas Sheffield United Kingdom Neurology Academy 464 -466 Sheffield S36 2DU 500 111,4 611,4 Dr Alec Ming East Yorkshire United Kingdom Hull Royal Infirmary Anlaby Road Hull HU3 3JZ 500 15,6 515,6 Dr Claudia Ruffman Basingstoke United Kingdom Basingstoke & North Hampshire Hospital Aldermaston Hamshire RG24 9NA 400 400 Dr Naila Ismayilova London United Kingdom Chelsea & Westminster Hospital 369 Fulham London SW10 9NH 350 350 Dr Charlotte Lawthom Hengoed United Kingdom Aneurin Bevan University Health Board Ystrad Fawr Way Ystrad, Mynach, CF82 7EP 3270 3270 Dr Doug McCorry Birmingham United Kingdom Queen Elizabeth Hospital Neurology Dept, Birmingham B15 2TH 700 700 Dr Carl Christian Moore Staffordshire United Kingdom Royal Stoke Univeristy Hospital Newcastle Road Staffordshire ST4 6QG 700 168 868 Dr Kasia Sieradzan Bristol United Kingdom Southmead Hospital Southmead Bristol BS10 5NB 700 700 Ms Emma Baker Tiverton United Kingdom Royal Devon & Exeter NHS Foundation Tiverton District Tiverton EX16 6NT £700 700 Ms Jennifer Dawber Preston United Kingdom Royal Preston Hospital Sharoe Green Preston PR2 9HT 125 125 Dr Francesca Morgante London United Kingdom St Georges University Hospital London London SW17 0RE 1600 52,33 1652,33 Dr Lara Teare Coventry United Kingdom UHCW Clifford Bridge Coventry CV22DX 400 400 Dr Matthew Lloyd Birmingham United Kingdom UHB Mindelsohn Birmingham B15 2TH 400 400 Dr Cristina Simonet London United Kingdom Queen Mary University of London Mile End Road London E1 4NS 650 650 Prof Raj Gupta Birmingham United Kingdom Birmingham Childrens Hospital Steel House Lane Birmingham B4 6NH 750 750 Prof Donald Grossett Glasgow United Kingdom Queen Elizabeth Univeristy Hospital Langlands Drive Glasgow G51 4LB 2050 531,66 2581,66 Ms Amanda Hulejczuk West Sussex United Kingdom Princess Royal Hospital Lewes Road, West Sussex RH16 4EX 500 51,8 551,8 Dr Annette Hand North Sheilds United Kingdom North Tyneside General Hospital Rake Lane Tyne & Wear NE29 8NH 800 298,5 1098,5 Dr Rebecca Davenport Manchester United Kingdom Manchester Royal Infirmary Oxford Road Manchester M13 9WL 850 196 1046 Prof Nicola Pavese Newcastle United Kingdom Univeristy of Newcastle Newcastle Upon NE4 6BE 850 45 895 Dr Lara Teare Coventry United Kingdom UHCW Clifford Bridge Coventry CV22DX 850 91,5 941,5 Ms Miriam Parry London United Kingdom Kings College Hospital Denmark Hill London SE5 9RS 1000 1000 Dr Jonathan Evans Nottingham United Kingdom Queens Medical Centre Derby Road Nottingham NG7 2UH 850 850 Prof Annette Schragg London United Kingdom Royal Free Hospital Pond Street, London NW3 2QG 850 850 Prof Norman Delanty Dublin Ireland Beaumont Hospital Beaumont Road, Dublin Dublin 9 1000 1000 Dr Prasad Korlipara London United Kingdom Queens Square Private Consulting Rooms 23 Queens London WC1N 3BG 600 600 Dr Petr Vokurka London United Kingdom National Hospital for Neurology & 33 Queens London WC1N 3BG 250 250 Dr Camille Carroll Plymouth United Kingdom University of Plymouth Drake circus Plymouth PL4 8AA 443 443 Dr Basil Ridha East Sussex United Kingdom Royal Sussex County Hospital Brighton East Sussez BN2 5BE 600 600 Dr Rhys Thomas Newcastle United Kingdom Royal Victoria Infirmary Queen Victoria Newcastle Upon NE1 4LP 112,5 112,5 Dr Arshad Rather London United Kingdom UCL 250 Euston Road London NW1 2PG 850 850 Prof Carl Clarke Birmingham United Kingdom City Hospital Dudley Road Birmingham B18 7QH 850 77,2 927,2 HCPs and ORDMs HCPs and Dr Robin Fackrell Bath United Kingdom Royal United Hospitals NHS Foundation Combe Park Bath BA1 3NS 850 99,3 949,3 Dr Prasanth Reddy London United Kingdom Kings College Hospital Denmark Hill London SE5 9RS 850 850 Dr Kate Brown Leeds United Kingdom Leeds General Infirmary Great George Leeds LS1 3EX 691,53 933,54 1625,07 Dr Alice Manson Southampton United Kingdom Southampton University Hospital Tremona Road, Southampton SO16 6YD 691,53 933,54 1625,07 Dr Caroline Budu London United Kingdom The Royal London Hospital, Whitechapel London E1 1BB 691,53 933,54 1625,07 Ms Sarah Craw Yeovil United Kingdom Yeovil District Hospital NHS Foundation High Kingston, Yeovil BA21 4AT 691,53 933,54 1625,07 Ms Gillian Forwood Swansea United Kingdom Parkinson's Treatment Centre Gorseinon Swansea SA4 4UU 691,53 933,54 1625,07 Dr Prasad Korlipara London United Kingdom National Hospital for Neurology & Neurosciences London WC1N 3BG 691,53 933,54 1625,07 Dr Ravisanker Moorchilot Nottingham United Kingdom Queens Medical Centre Derby Road, Nottingham NG7 2UH 518,64 933,54 1452,18 Dr Rebecca Davenport Manchester United Kingdom Manchester Royal Infirmary Oxford Road Manchester M13 9WL 691,53 933,54 1625,07 Dr Romi Saha London United Kingdom Kings College Hospita Denmark Hill London SE5 9RS 691,53 933,54 1625,07 Dr Alastair Lansbury Bradford United Kingdom St Luke's Hospital Department of Bradford BD5 0NA 691,53 933,54 1625,07 Dr Benjamin Wright Birmingham United Kingdom Queen Elizabeth Hospital Mindelsohn Birmingham B15 2TH 518,64 933,54 1452,18 Dr David Breen Edinburgh United Kingdom Royal Infirmary of Edinburgh Centre for Edinburgh EH14 4SB 518,64 720,19 1452,18 Dr Ffion Thomas Swansea United Kingdom Gorseinon Hospital Parkinson's Swansea SA4 4UU 691,53 933,54 1625,07 Dr Gordon Duncan Edinburgh United Kingdom Western General Hospital Consultant Edinburgh EH4 2XU 518,64 933,54 1452,18 Dr Jan Coebergh Surrey United Kingdom Ashford & St Peters Hospitals Foundation Neurology Surrey KT16 0PZ 518,64 933,54 1452,18 Dr Jason Raw Bury United Kingdom Fairfield General Hospital Rochdale Old Bury BL9 7TD 691,53 933,54 1625,07 Dr Amrit Samra Coventry United Kingdom University Hospitals Coventry & Clifford Bridge Coventry CV2 2DX 518,64 933,54 1452,18 Dr Khin Nini Darlington United Kingdom Darlington Memorial Hospital Hollyhurst Road Darlington DL3 6HX 691,53 933,54 1625,07 Dr Nashantha Silva Grantham United Kingdom Sherwood Forest Hospitals NHS Foundation 30 Grampian Grantham NG31 8FY 518,64 933,54 1452,18 Ms Caroline Arnold Leeds United Kingdom Leeds General Infirmary Great George Leeds LS1 3EX 691,53 933,54 1625,07 Ms Marilyn Turner Norwich United Kingdom Norfolk & Norwich University Hospital NHS Colney Lane Norwich NR4 7UY 691,53 933,54 1625,07 INDIVIDUAL Dr Richard Walker North Sheilds United Kingdom North Tyneside General Hospital Rake Lane North Shields NE19 8NH 518,64 933,54 1452,18 Dr Francesca Magrinelli London United Kingdom UCL Queen Square Institute of Neurology Queens Square London WC1N 3BG 284 284 Dr Melissa Mackenzie London United Kingdom National Hospital for Neurology & Queens Square London WC1N 3BG 284 284 Dr Eoin Mulroy London United Kingdom UCL Queen Square Institute of Neurology Queens Square London WC1N 3BG 284 284 Prof Andrew Lees London United Kingdom Univ College London Hosps NHS FT - Queens Square London WC1N 3BG 868,75 1219,09 2000 4087,84 Prof Tom Foltynie London United Kingdom Univ College London Hosps NHS FT - Queens Square London WC1N 3BG 4000 4000 Prof Fenella Kirkham Southampton United Kingdom University Southampton NHS FT Tremona Road, Southampton SO16 6YD 1286,99 1286,99 1451,96 Dr Valentina Leta London United Kingdom The Maurice Wahl Clinical Neuroscience Kings College, London SE5 9RT 518,64 518,64 OTHER, NOT INCLUDED ABOVE - where information cannot be disclosed on an individual basis for legal reasons Aggregate amount attributable to transfers of value to such Recipients - Art.