MEDICAL EQUIPMENT LENDING AGREEMENT FORM | VALLEY CHARITIES, INC.

Dear Valley Resident,

Valley Charities, Inc. and Turn-A-Leaf Thrift Store staff are delighted to provide to medical equipment lending program in your time of need. The medical equipment lending program has supported Valley residents for several decades at no cost, and we need your help so that this program can continue to thrive and assist more people in the Valley. Unfortunately, this lending program does not come without a cost to preserve the medical equipment.

Additionally, Valley Charities, Inc. and Turn-A-leaf Thrift Store do not have the means to support unnecessary neglect to the medical equipment. Your respectful care of the medical equipment will enable a prompt return to service for other Valley residents and save us money that we can apply to our other valuable service programs.

Borrowers/Users are encouraged to seek the advice of a qualified  professional on proper use of all medical equipment.

GUIDELINES:

1)  The borrower or user must be a resident of the Mat-Su Valley.
2)  The maximum loan time is six months from the original loan date.
3)  The medical equipment must not leave the state of Alaska.
4)  All medical equipment can be returned within 30 days of the scheduled return date. (Monday to Saturday 10 a.m.-3 p.m.)
5)  The medical equipment must only be used for its intended purpose.
6)  Please return the medical equipment clean after you have used it.
7)  Any damage to the medical equipment will be paid by the borrower/user.
8)  All loaned medical equipment remains the property of Valley Charities, Inc.

To serve your medical equipment needs in a safe and efficient manner please note:

Medical equipment will no longer be issued after 5 p.m.

Due to the lack of appropriate staff levels. However, there is one exception; if you call by 1 p.m., we can arrange to have the medical equipment pulled and waiting for you on the same day.

Staff will no longer be able to assist moving hospital beds from your vehicles after 3 p.m.

Please be aware that we do not have the appropriate staff levels after 3 p.m. to safely move hospital beds.

Despite these changes, you still have ample opportunity to borrow or return medical equipment six days a week:  Monday to Saturday 10 a.m. to 3 p.m.

We are pleased to have this money saving resource available for you to use.

Medical equipment lending agreements instructions

  • Responsible person borrowing equipment:
      1. The writing on the agreement must be legible to read
      2. If not, please talk with the borrower for the information that is in clear and print next to the appropriate area.
      3. Medical equipment does not leave unless all areas on the form need are fully completed.
      4. Medical equipment does not leave unless the printed name and signature of the responsible person have acknowledge reading and agreeing to the guidelines listed on the stapled page.
      5. Medical equipment numbers are listed in the correct box on the equipment chart
      6. Separate the white copy from the other copies.
      7. The responsible person should take the yellow copy of medical equipment agreement and stapled double-sided page.
      8. The white copy goes back to the office for processing.
  •  Responsible person returning the borrowed medical equipment
      1.  Medical equipment is checked for cleanliness and any damage
      2. Notations need to be in the appropriate chart box acknowledging the condition of the returned equipment in conjunction with the date returned.
      3. Responsible person signs and dates the bottom of our white copy.
            a) If requested, you can make a copy of the white form for them.
      4. White copy goes back to the office for processing.