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APPROVAL SHEET

And COMPLIANCE UNDERTAKING

Please complete the corresponding Approval Sheet and Compliance Undertaking for your Program:

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

*Healthcare Professional means any member of the medical, dental, pharmacy or nursing profession or any other person who, in the course of his/her professional activities, may prescribe, recommend, purchase, supply, administer or dispense a health product accordingly.

**Healthcare Organization means either a health care, medical or scientific associations, or organizations such as hospital, clinic, university or other institutions or learned society whose business address, place of incorporation or primary place of operation is in the Philippines or an organization through which one or more health care professionals or other relevant decision-makers provide services

ANNEX “A”

Activity Involving Giving Educational Items and Gifts to a Healthcare Professional (HCP)
This activity is not in exchange for the HCP’s prescription of the Company’s product.	Yes _____	No _____
The item to be given has a direct patient benefit or is related to the work of the HCP.	Yes _____	No _____
The item will not be given to any member of the HCP’s family.	Yes _____	No _____
The value of the item is reasonable considering the patient benefit.	Yes _____	No _____
This activity will not include any form of entertainment that will entail costs.	Yes _____	No _____
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 _____
The recipient is not a government employee.	Yes _____	No ______

I hereby certify that our Compliance Officer has approved this activity. I further certify that the information provided above are true and correct.

______________________________

Name

Designation

Note: If any of the applicant’s answer to the question above is a “No”, then the activity is automatically denied.

ANNEX “B”

Activity Involving Giving of Promotional Aids/Medical Utility to a HCP
This activity is not in exchange for the HCP’s prescription of the Company’s product.	Yes _____	No _____
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 _____
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 _____
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 _____
The value of the item is modest.	Yes _____	No _____
This activity will not include any form of entertainment that will entail costs.	Yes _____	No _____
The item does not have entertainment or recreational benefits.	Yes _____	No _____
The item is not a financial rebate to a doctor.	Yes _____	No _____

I hereby certify that our Compliance Officer has approved this activity. I further certify that the information provided above are true and correct.

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