Application for Oxygen Concentrator use
SUBANG JAYA ASSEMBLY OF GOD

Criteria:
1. The intended user must have been tested and confirmed Covid-19 positive via PCR or RTK or home saliva test kit. This critical equipment is reserved for Covid-19 cases.

2. User must be experiencing breathing difficulty; has an oximeter reading of below 90 and is awaiting transportation or for an available place to be admitted to health care facility or for after-Covid care.

3. User must have been assessed by a medical doctor and deemed suitable for home monitoring with this equipment. At the slightest distress the user must seek emergency medical help.

Conditions for use/loan
1. This equipment is for use/loan free-of-charge made available by Subang Jaya Assembly of God (SJAG). Freewill donation to SJAG is encouraged to maintain continual service to other users.

2. It is for use by members and those referred to by church members who can vouch for the responsibility and care for the equipment. Care for the equipment must be exercised by all users.

3. This equipment is not for long term life-sustaining but for use while waiting for help to arrive and for necessary after-Covid care

4. The equipment is to be returned immediately to SJAG when not in use any more so that other users can benefit.

5. It is the responsibility of the user to follow instruction for proper functioning of the equipment. User have to get medical advice on the level of concentration to administer. SJAG is not responsible for whatever unfortunate happenings while the equipment is being used. It is agreed that the use of the equipment is not to avoid hospital admission for treatment and the user or family members will not hold SJAG liable for any mishap. A brief operating procedure is found in the unit.

6. The equipment cannot be transferred to another location or person without express permission from SJAG.

7. The use of the equipment is subject to availability and on a first come first serve basis. User can contact the church to enquire on the availability.
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The user/borrower below hereby agreed to all the terms stated above and pledge to care and maintain the proper functioning of the equipment.
Name of borrower *
Handphone No. of borrower *
Location/Address *
Name of Referrer (Church Member) *
Handphone No. of Referrer *
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