For the purpose of teleconsultation for Covid-19 patient, FV Hospital agrees to lend the equipment to the person specified in the reqest for equipment loan, including pulse oximetry and temperature measuring devices, in accodance with the terms of this Equipment Loan Agreement. Total deposit amount is VND 5,000,000.
The devices will be used by the patient for free of charge during 12 days included in the FV Covid-19 telemedicine package. After these 12 days, the patient must return the devices to FV hospital. The late fee will be charged at VND 300,000 for each day of delayed return.
AGREEMENT TO TERMS OF EQUIPMENT LOAN AND ACKNOWLEDGEMENT OF USE
By signing this form, I agree to borrow the above named equipment upon the terms and conditions stated herein for use by me/my dependent. I further agree to be responsible to maintain the equipment in good condition and to protect the equipment from water and moisture, to ensure the equipment is only used for the purpose for which it was intended and to return the equipment on the Requested Return Date specified above. I understand that should any damage be caused to the equipment whilst it is in my/my dependent’s care that I may be liable to compensate FV Hospital therefore up to the full replacement value, subject to FV Hospital’s policy and discretion. I further understand and agree that should I/my dependent return the equipment after the Requested Return Date specified above, I will be subject to payment of the daily Late Fee noted above. The late fee will be VND 300,000 per day after 12 days since the date you receive