Applying of basic medicines

By Bill WilsonBusiness reporter, BBC News

Apple has been called "an American success story" by the Senate panel

Apple's tax methods have been unpicked by a US Senate committee that has accused the company of being "among America's largest tax avoiders".

Carl Levin, chairman of the Senate Permanent Subcommittee on Investigations, said Apple, making use of the tax system in the Republic of Ireland, "shifts billions of dollars in profits offshore" that should be subject to US taxes.

He said Apple had a highly developed tax avoidance system through which it had amassed more than $100bn (£66bn) in offshore cash.

The committee said Apple - which Mr Levin called "an American success story" - had created a "complex process" to avoid paying taxes. His committee had earlier said there had been no indication the firm had acted illegally.

In its prepared testimony Apple said it "does not use tax gimmicks".

That assertion was questioned by tax expert Prof Richard Harvey, of Villanova University, who opened his testimony to the Senate committee by saying he "almost fell out of my chair" when he heard the remark.

Tax avoidance 'staples'

Mr Levin outlined what he and his colleagues said were "a complex web of offshore entities" that Apple used to avoid paying billions of dollars in US taxes.

The Democratic senator for Michigan said sending valuable intellectual property rights offshore - together with the profits that follow those rights - was at the heart of Apple's tax-avoidance strategy.

Unlike more tangible, physical assets, he said, the value of those property rights could be transferred around the globe, often with just a few keyboard strokes.

"Some of Apple's techniques are staples of international tax avoidance, such as its use of what is known as a 'cost sharing agreement' between the parent company and its offshore subsidiaries, and its use of so-called 'check-the-box' regulations," he said.

'Holy Grail'

But he added that many of Apple's other measures were "unique".

"Apple has sought the Holy Grail of tax avoidance, offshore corporations that it argues are not, for tax purposes, resident in any nation." said Mr Levin.

He explained how the tech company had made the most of a loophole in the Irish tax code that was designed to help the country compete with other countries for investment and jobs.

It meant the iPhone maker was able to funnel profits into Republic of Ireland-incorporated subsidiaries or "ghost companies" that had "no declared tax residency anywhere in the world".

Under Irish law, only companies that are managed and controlled in Ireland are considered Irish residents for tax purposes.

Hence, Apple Operations International (AOI), Apple Sales International (ASI) and Apple Operations Europe - through which much of the Apple group's overseas income has flowed - are all incorporated in Ireland but are not deemed to be tax resident there, as they are not managed and controlled in the country.

But US tax law, on the other hand, generally turns on where a company is incorporated, not on where it is managed and controlled.

Apple has arranged matters so it can claim that these offshore entities, for tax purposes, exist nowhere.

'Tax haven'

The firm designated its Irish entities as unlimited companies, which meant it did not have to publish annual accounts. The Senate inquiry has been the first time the structure has been publicly revealed.

The Irish arrangement allowed Apple to pay just 1.9% tax on its $37bn in overseas profits in 2012, despite the fact average the tax rate in the OECD countries that make up its main markets was 24% last year.

In a 40-page memorandum, the Senate committee says: "Ireland has essentially functioned as a tax haven for Apple."

The Irish government has said the country is not to blame for Apple's low global tax payments, and that it had no special-rate deal with the company.

Applying of basic medicines

Application of different medicines called pharmacotherapy. It studies natural matters (herbares, minerals and others like that), and also – synthesized in chemical way.

Classification of medicines

In mechanism of therapeutic action:

Etiotropic – medicines, that directly influences on the cause of disease (for example, antibiotics).

Nosotropic – medicines that influences on the certain links of pathological process (antihypertensive medicines in patients with arterial hypertension).

Symptomatic – medicines have been prescribed with a purpose of removals of certain symptom (medicines for pain relief in patients with arterial hypertension; headacke often accompanied hypertensive crisis).

Substitute – medicines that supply the lack of some matter in organism (vitamins, hormones, enzymes).

In the place of action:

Local – medicines act directly on the tissue (ointments, graze, powders and others like that).

General –medicines act on the whole organism after it’s administration in blood.

Requirements for the medicines from the drug store produce the senior nurse. Requirements are write out in 3 examples. On the poisons, narcotic medicines, strong medicine, ethyl spirit senior nurse write out 1 sample more. Requirements are signed by chief and certified by hospital signet. The requirements on the receiving of poisons, narcotic medicines, strong medicine nurse should assign name, surname, No. of history case. In reception senior nurse should check the requirement (name, doze), date of production and expl. date, serial number, accordance to the origin packing or drug store wrapping.

All medications must be kept out of sight within the medical office. One central area, such as a closed medicine closet, accessible to medical office staff only, provides the best security for medications, rather than keeping a medicine cabinet in every patient room.

Even the simplest medications, such as aspirin or antacid tablets must not be given out to patients who might have requested a sample without prior authorization from the physician! Each time a patient receives a small sample of a drug, this should be documented in the patient records indicating the name of the drug, who authorized its dispensal, and that the patient was informed about the sample drug's action, side-effects, and how to take it followed by the medical assistant's (or healthcare professional's) initials.

Date: 2014-12-29; view: 990