If you are interested please e-mail me directly to the address in footer and I would be happy to mail you a copy. Happy Thanksgiving! Ann Hoffmann| ALS Associatin MN Chapter, Coordinator for the Hrbek-Sing Communication and Assistive Device Program | PH: 763-520-0445 | Fax: 763-520-0355|Courage Center | 3915 Golden Valley Road | MPLS, Minnesota 55422 xxxxxx@xxxxxxxxxxxxxxxxx | CourageCenter.org ------------------------------------------------------------------------ ------- This e-mail message is for the sole use of the intended recipient(s) and contains confidential and/or privileged information. Any unauthorized disclosure, copy or distribution of this information is strictly prohibited. If you are not the intended recipient, please notify the sender and delete this e-mail. -----Original Message----- From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of June Huysman-Morris Sent: Wednesday, November 26, 2008 8:59 AM To: xxxxxx@xxxxxxxxxxxxxxxxxxxx Subject: RE: [Assistive Technology] Equipment Loan Liability May be helpful! Can they send us a copy of their actual agreement do ya think? >>> "Ann Hoffmann" <xxxxxx@xxxxxxxxxxx> 11/17/2008 9:50 AM >>> Do you have any problems with getting the signed forms back? We have a Rehab Aide that will call if forms are not returned. If we still do not get forms returned we ask the ALSA representative at clinic to follow up directly with the family to retrieve the form. Now, do we have glitches? Yes. Sometimes forms still are not returned but if you look at the process in the answer below we have a copy of what is loaned even if it is not signed. When are people asked to sign the loan agreement? Is it presented to them when they receive the equipment? Is it sent before or after the patient receives the equipment? Let me preface my explanation with this statement: . It is not an Eco-Friendly process. When presented in person, individuals are asked to sign the loan agreement at the time the equipment is provided (usually same day as treatment unless it is an exchange when something is being repaired). The loan agreement is a triplicate carbon form. Therapists complete the form, explain the loan agreement, and the patient signs the form. The middle form is the consumer's copy. The top copy is returned to the Rehab Aide for filing and database entry. The final copy is left in the consumer's file for the therapist's records. Should equipment be mailed to the home of the individual, using the same loan agreement, we mail a cover letter explaining the need for the family to sign the Loan Agreement form for equipment tracking purposes and to keep the "Yellow" copy of the form the form is mailed to the patient. We only mail the top and second copy completed to the family and keep the last copy so we have a record of what was loaned. It is a nice back up in the event the loan agreement is not returned. This information can be used to attempt to retrieve the loan agreement with the Rehab Aide calling to leave a voice message as a reminder to return agreements or speak directly with the individual. If we do not get this form returned we notify the ALSA representative to follow up with the family by telephone or when attending the next ALS Clinic. Please let me know if you need further clarification. Ann Hoffmann| ALS Associatin MN Chapter, Coordinator for the Hrbek-Sing Communication and Assistive Device Program | PH: 763-520-0445 | Fax: 763-520-0355|Courage Center | 3915 Golden Valley Road | MPLS, Minnesota 55422 xxxxxx@xxxxxxxxxxxxxxxxx <mailto:xxxxxx@xxxxxxxxxxxxxxxxx> | CourageCenter.org <http://www.couragecenter.org/> ------------------------------------------------------------------------ ------- This e-mail message is for the sole use of the intended recipient(s) and contains confidential and/or privileged information. Any unauthorized disclosure, copy or distribution of this information is strictly prohibited. If you are not the intended recipient, please notify the sender and delete this e-mail. ________________________________ From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Antoinette Verdone Sent: Monday, November 17, 2008 10:04 AM To: xxxxxx@xxxxxxxxxxxxxxxxxxxx Subject: RE: [Assistive Technology] Equipment Loan Liability Do you have any problems with getting the signed forms back? When are people asked to sign the loan agreement? Is it presented to them when they receive the equipment? Is it sent before or after the patient receives the equipment? Antoinette Verdone, MSBME, ATP Assistive Technology Specialist The ALS Association, Greater New York Chapter 116 John Street, Suite 1304 New York, NY 10038 Phone: 212-720-3054 Fax: 212-619-7409 Email: xxxxxx@xxxxxxxxxx www.als-ny.org "One cannot consent to creep when one has the impulse to soar" -- Helen Keller ________________________________ From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Ann Hoffmann Sent: Monday, November 17, 2008 9:19 AM To: xxxxxx@xxxxxxxxxxxxxxxxxxxx Subject: RE: [Assistive Technology] Equipment Loan Liability The MN Chapter mails a Lease for Loan Agreement to all PALS registered in ALSA MN Chapter explaining in detail the terms in which the individual is going to keep, maintain equipment, and contact the chapter should something happen to the equipment. When equipment is no longer used, individuals are asked to return it as soon as possible so others may use it. In addition to this form, we have a separate Hrbek-Sing Loan agreement we have individuals sign and receive a copy to keep for their records of the equipment (AAC devices, switches, headpointing systems, etc.) loaned that is later entered in a database at the ALSA MN Chapter. Hopefully this is helpful! Ann Hoffmann| ALS Associatin MN Chapter, Coordinator for the Hrbek-Sing Communication and Assistive Device Program | PH: 763-520-0445 | Fax: 763-520-0355|Courage Center | 3915 Golden Valley Road | MPLS, Minnesota 55422 xxxxxx@xxxxxxxxxxxxxxxxx <mailto:xxxxxx@xxxxxxxxxxxxxxxxx> | CourageCenter.org <http://www.couragecenter.org/> ------------------------------------------------------------------------ ------- This e-mail message is for the sole use of the intended recipient(s) and contains confidential and/or privileged information. Any unauthorized disclosure, copy or distribution of this information is strictly prohibited. If you are not the intended recipient, please notify the sender and delete this e-mail. ________________________________ From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Antoinette Verdone Sent: Friday, November 14, 2008 2:44 PM To: xxxxxx@xxxxxxxxxxxxxxxxxxxx Subject: [Assistive Technology] Equipment Loan Liability I have a question about loan closet liability. This probably is more relevant for DME. What are chapters doing as far as having patients sign some sort of agreement absolving the chapter of any liability of the use of the loaner equipment? If you have an agreement that is signed, do you have people sign before they get equipment? If not, do they sign it after they get the equipment, or at another time? What do you do if you do not receive a signed agreement from the patient? I would like to hear what others are doing. Antoinette Verdone, MSBME, ATP Assistive Technology Specialist The ALS Association, Greater New York Chapter 116 John Street, Suite 1304 New York, NY 10038 Phone: 212-720-3054 Fax: 212-619-7409 Email: xxxxxx@xxxxxxxxxx www.als-ny.org "One cannot consent to creep when one has the impulse to soar" -- Helen Keller ______________________________________________________________________ All Inbound Courage Center email is scanned by the MessageLabs Email Security System. For more information please visit http://www.messagelabs.com/email ______________________________________________________________________ ______________________________________________________________________ All Inbound Courage Center email is scanned by the MessageLabs Email Security System. For more information please visit http://www.messagelabs.com/email ______________________________________________________________________ ______________________________________________________________________ All Inbound Courage Center email is scanned by the MessageLabs Email Security System. For more information please visit http://www.messagelabs.com/email ______________________________________________________________________
