Have you received a donation of medical equipment in the last few years?
We would appreciate your help
AN APPEAL ON BEHALF OF ROTARY HEALTHCARE FELOWSHIP
There are many Rotary projects which include the supply of medical equipment - new and old. We would like to compile a database of such projects to help those who are planning new projects. We're reaching out to you in the hope that you will assist us in this. Please complete this form as best as you can. Thank you in advance for your cooperation.
1. Your Name
First Name
Last Name
2. Email
example@example.com
3. Phone Number
Please enter a valid phone number.
4. Recipient Rotary Club (main club if more than one)
Club
District, Country
5. What types of medical equipment?
Consumables (gloves, dressings, bandages, syringes etc)
Low tech (beds, mattresses, BP apparatus, ward equipment etc)
High tech (X-ray machines, lab equipment, autoclaves etc)
Other
If 'other' please use this space to give a brief description and add any additional information
Our aim is to find out what type of medical items are transferred through Rotary
6. Who decided about the items you received? Did you have a 'wish list'? Please briefly describe how the project started?
Sometimes a key person from the donor club instigates such projects.
7. Approximate value of the items received in USD
If not sure please enter 'Not Sure'
8. Approximate cost (procurement, servicing, storage, customs, shipping etc) of the project in USD (excluding the value of the donated items)
If not sure please enter 'Not Sure'
9. Did you incur any cost - if so how did you meet the cost?
The Rotary Foundation (Global Grant), District Grant, Club or other sources?
10. If there were any 'high tech' items, who installed them? Was there any training? Did you receive manuals? Please comment whether the equipment needs regular servicing and if so who will do this? Do you have the funds for servicing and any spares?
11. Where is the equipment located? Are they currently in use? Who provides maintenance or repairs?
12. Please briefly state the impact of this project on services and patient care, especially mentioning any new service provided.
13. Please share any relevant documents especially MOU, training manuals, maintenance agreements, follow up reports
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14. Is there any lesson you would like to pass on to colleagues? Three things that went well and three things that could have been done differently.
15. Are you happy to be a resource for others planning similar projects?
Yes
No
Other
16. Donor Rotary Club or Recipient organisation
Club/Organisation
Rotary District/Town, Country
17. Please enter the month and year of your donation.
18. If shipping was involved please share your experience of shipping, customs and any other logistic issues you wish to highlight.
Date
-
Month
-
Day
Year
Date
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