Beechdale Health Centre
Equipment Loan Protocol, Loan Agreement & Register
Document Control
A. Confidentiality Notice
This document and the information contained therein is the property of Beechdale Health Centre.
This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from Beechdale Health Centre.
B. Document Details
Classification:Author and Role:
Organisation: / Beechdale Health Centre
Document Reference:
Current Version Number:
Current Document Approved By:
Date Approved:
C. Document Revision and Approval History
Version / Date / Version Created By: / Version Approved By: / CommentsIntroduction
This document identifies the procedure that staff within the Practice will adopt when loaning equipment to a Patient. Its purpose is to enable the issue and recovery of Practice loan equipment and facilitate record keeping which will ensure that the location of the equipment is known at all times.
Procedure for Issuing Loan Equipment:
On receipt of a request for an item of equipment to be loaned, the name and address of the Patient and the details of the equipment will be passed to Receptionists/practice nurse, who is responsible for co-ordinating and issuing loan equipment from the Practice.
Upon receipt of a request for an item of equipment to be loaned:
1. Confirm the item is available and it is to be loaned on a short-term basis (i.e. 1 week or less).
2. If the item is to be on loan for a period in excess of a week, authorisation is to be obtained from Snr Receptionist
3. Two identical copies of an Equipment Loan Agreement Form (See Example in Appendix A) should then be completed:
a) Complete the top part of the Loan Agreement using the appropriate serially numbered form relating to the serial number on the equipment.
b) Add any comments regarding condition of equipment, noting any damage.
c) Ensure the Patient understands how to use the equipment correctly.
d) Hand-over the equipment and any accompanying information leaflet to the Patient.
e) Obtain the Patient’s Signature for acceptance of the Loan Agreement conditions.
f) Collect the deposit value as indicated on the form, and issue a receipt.
g) Place the deposit in the Practice deposit cash-box and lock the box.
h) File one copy of the Equipment Loan Agreement form in the “Equipment on Loan” folder. Complete the Equipment Loan Register (See Example Template in Appendix B)
Procedure for Receiving Returned Loan Equipment:
When loan equipment is returned:
1. Retrieve the appropriate Loan Agreement Form from the “Equipment on Loan” folder.
2. Check the equipment for any damage which was not noted when it was issued and verify that it is complete.
3. Complete the return details on the Loan Agreement Form, noting the condition and any damage.
4. Complete the return details on the Patient’s copy of the Loan Agreement Form.
5. If the equipment is returned in the same condition and within the agreed loan period, return the full deposit amount to the Patient.
6. Contact Snr Receptionist if the equipment has been returned in a different condition to that when it was issued and / or has been returned outside the agreed loan period.
7. File the Loan Agreement Form in the “Equipment Loans Completed” folder.
8. Update the Equipment Loan Register and return the Equipment to Loan Stock.
Beechdale Health Centre
Appendix A - Equipment Loan Agreement Form
This agreement is made between the Practice and:
Patient Name:Patient Address:
Details of Equipment to be loaned:
Equipment Description:Serial Number:
Next Service Due Details: / Deposit Paid:
Loan Period: / From: / To:
Comments on Equipment Condition:
Terms and Conditions of the Equipment Loan:
1. The Practice will keep the equipment in good condition and repair and will test that it is fully working and in good order prior to issue.
2. The Patient agrees to make the deposit specified above which will be refunded in full if the equipment is returned in full working order by the date specified above (excluding fair wear and tear).
3. The equipment is only to be used by the Patient named above.
4. The Practice will instruct the Patient on the correct use of the equipment, however it is not responsible for failure to use the equipment correctly once it has left the premises.
5. The Patient agrees in the event of the equipment developing a fault, it is reported immediately to the Practice. The Practice will arrange for either timely repair or replacement of the item at no additional cost to the Patient.
6. The Patient will not modify or attempt to modify the equipment, or use it in any way inconsistent with its purpose.
7. The equipment is supplied for the maximum loan period detailed above and is due to be returned on or before the date specified.
8. The loan period may be extended only by the written agreement of the Practice in the form of a new agreement covering the revised, additional period.
9. The Patient is responsible for the return of the equipment by the due date specified.
10. As evidence that the item has been returned, the Patient must obtain a signed receipt by a staff member on the Patient’s copy of this agreement.
11. The Patient, in accepting the loan of the equipment, warrants that they have home or personal insurance in force to cover loss or damage (including accidental damage) to the equipment, both in the home and elsewhere whilst under their control, on a “new-for-old” basis.
12. The Patient agrees in the event of damage or loss to the equipment, the Practice will be informed immediately and the Patient will make a claim on their insurance policy. The Patient also agrees to forward all proceeds of the claim to the Practice for an agreed amount.
13. The Patient agrees that where there is a shortfall between the cost of a direct or compatible replacement item and the value of the settled insurance claim, the cost of the shortfall is their responsibility and they will reimburse the Practice accordingly.
14. The Patient agrees that where the equipment is not returned on or before the date specified, the Practice will levy a daily rental fee equivalent to ***Insert percentage – e.g. 10%*** of the original deposit, until such time as the value of the deposit is exhausted.
15. After this time, the Patient will pay the Practice the full replacement value, or return the equipment in full working order.
16. In the event that the Patient does not comply with the above, the Practice reserves the right to commence legal action to cover the equipment or its equivalent cost, which will also include the daily rental charges accrued for each additional day.
I confirm that I have explained to the Patient how to use this equipment, the terms and conditions of the loan, and issued it on a loan basis.
Signed (Staff Member): ______
Print Name: ______
Date: ______
I accept this equipment in good condition and agree I will return it by the date given above and in the same condition:
Signed (Patient): ______
Print Name: ______
Date: ______
RETURN DETAILS
Date Returned: / Value of Deposit Returned:Equipment Condition:
Comments:
Signed (Staff Member): ______
Print Name: ______Date: ______
Doc. Ref – Version – Filename: Equipment Loan Protocol, Loan Agreement & Register Page 5 of 5
Beechdale Health Centre
Appendix B - Equipment Loan Register
Equipment Description / SerialNumber / On loan to:
Patient Name / Loan
Start Date: / Loan
Return Date: / Equipment Returned to stock in Good condition.
Doc. Ref – Version – Filename: Equipment Loan Protocol, Loan Agreement & Register Page 5 of 5