LeessMDI program

ANNEX B

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

A. This activity is not in exchange for the HCPs prescription of

Yes _X_ No _____
the Companys product.
B. 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, Yes _X_ No _____
subscriptions to medical journals or anatomical models).
C. The item is a promotional aid (i.e., non-monetary item given to an HCP
N/A
for promotional purpose). [If the answer is N/A, skip items C.1. and Yes _X__
_____
C.2. below.]
C.1. The item is relevant to the practice of the HCPs profession or
Yes _X_ No _____
education of the patients.
C.2. The item serves a genuine promotional or educational value. Yes _X__ No _____
D. 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. Yes _X_ N/A ___
below.]
D.1. The item will benefit the patient or serve a genuine educational
Yes _X__ No _____
function for the HCP.
E. The value of the item is modest. Yes _X__ No _____
F. This activity will not include any form of entertainment that
Yes _X_ No _____
will entail costs.
G. The item does not have entertainment or recreational
Yes _X_ No _____
benefits.
H. The item is not a financial rebate to a doctor. Yes _X_ 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: Robert A. Rosales
Designation : District Manager
UAP, STAG R2

Note: If any of the applicants answer to the question above is a No, then the
activity is automatically denied.