The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

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Required format:

nwaItdbc9t4wRQREKDLFXJbmG3QYWk55qUakvoFU3c6zyqCFJnRSiiaZUqrxwGF

Gifts Benefit and Hospitality Register

Alfred Health’s policy on Gifts and Benefits requires all personnel to report any gift that is offered that has a value in excess of $50 – regardless of whether that gift is accepted.

Some of this information will be made publicly available through a register published on Alfred Health’s website.

If you have any questions about completing your entry into this register please call:

The Legal Department on (x65777) if your question relates to how to answer the questions; or

IT Helpdesk on (x63300) or by email on its.helpdesk@alfred.org.au if your question relates to technical difficulties in completing your entry

Please enter the date the benefit was offered:

D-M-Y

Please refer to the policy here:

Attachment:Gifts Benefits and Hospitality Policy.pdf

Select title:

First name:

Last name:

Department/Unit

Please enter a description of the gift, benefit or hospitality:

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Estimated value (to the nearest whole $)

Please estimate the total value of all gifts (including those worth less than $50) that you have received from this organization in this calendar year:

Offered by (name of person - if known):

Offered by (name of organisation):

Reason given by offeror for making the offer:

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Indicate whether the offer was:

accepted immediately

accepted with authorisation

declined

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If accepted:

would an external party reasonably believe that acceptance could alter Alfred Health's decisions

would acceptance harm Alfred Health's reputation

none of the above

This offer MUST be declined in accordance with the minimum accountabilities.

Please tick this box to acknowledge

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Is there a legitimate business benefit to Alfred Health:

Yes

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This offer MUST be declined

Please tick this box to acknowledge

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Please detail the business benefit that would accrue to Alfred Health by accepting this gift:

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Indicate whether the ownership of this offer was:

individually retained

transferred to organisation ownership

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Indicate whether this offer was:

returned to the offeror

other

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Please enter details:

Enter name of authorizer (Executive Director):

Authoriser position:

Authoriser department/unit:

Completed by:

Position:

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