Novo Nordisk Israel · Online forms

Needs Assessment Form
for HCP Speaker Services

Complete and sign prior to the contract being signed — a PDF is downloaded and emailed to the selected coordinator.

Guidance

  • Fill this form for all contracted HCPs individuals, either paid or unpaid.
  • The form must be completed and signed by the event owner for the engagement, prior to contract being signed.
  • For advisory board you can fill out one form.
  • Store the needs assessment document together with other documentation related to the engagement.

הנחיות

  • יש למלא את הטופס עבור כל התקשרות עם HCP, בין אם ההתקשרות בתשלום או לא.
  • על ה-Owner של הפעילות למלא ולחתום על הטופס לפני חתימה על ההסכם.
  • יש לתעד את הטופס יחד עם כל התיעוד הקשור לפעילות.

Assessment of the service need

1

Provide a detailed description of the service/activity you need to engage the individual for

Required
Required
Required
Please select a therapeutic area
2

What is the business objective of the service?

Select one or more options
3

How the engagement would fulfill approved plans or strategies

Select one or more options · options follow the therapeutic area chosen in section 1
Select a therapeutic area in section 1 to see the relevant strategies.
Obesity
Diabetes
CETA
4

Which selection criteria are needed to perform the service?

Select one or more options
5

Assessment of rehearsal and preparation time

For paid interactions
Round to the next half hour
Please make sure that the number of hours align with TEN requirements.
c. Hours of preparation are needed for: (select one or more options)
Guidance table: proof of service for preparation and rehearsal time

Sign-off

Must be filled if not prepared by the owner
Required
Required
Sign here with your mouse or finger
Draw your signature above
Signature is required
Required fields
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