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SABAH KIDNEY SOCIETY

AGREEMENT FOR SELF-CARE HAEMODIALYSIS PROGRAMME.

THIS AGREEMENT is made the                   day of                    2008

BETWEEN

THE SABAH KIDNEY SOCIETY having an address at No. 82, Taman Dah Yeh Villa, Jalan Damai, 88400, Kota Kinabalu, Sabah (hereinafter referred as "SKS" of the one part AND

of                                                                            (NRIC No.                                    )               (hereinafter referred to as the "Patient" of the other part.

WHEREAS

The SKS has set up a SKS DIALYSIS CENTRE (hereinafter called "the Centre") as a charitable project for the benefit of persons of limited means and income, resident in Sabah thereabout who require regular dialysis treatment.

The Centre is not a hospital but a self-care haemodialysis centre.

The Patient having been referred by his own Doctor, has applied to and is accepted by the selection committee of SKS to undergo dialysis treatment under the self-care haemodialysis programme.

NOW THIS AGREEMENT WITNESSETH as follows:

1. In consideration of several warranties and covenents given or undertaken to be performed by the Patient and his agreement to pay SKS the prescribed fee stipulated under Clause 4 hereof towards the cost of maintenance of the Centre, the SKS agrees to grant unto the Patient the right to use the facilities at the Centre on the terms and conditions hereincontained.

2. The Patient warrants that he:

a) has undergone adequate training in a recognised government run hospital or a private hospital or recognised dialysis centre or SKS Dialysis Centre;

b) is able, on his own operate a dialysis machine, to administer the needling process and to carry out the washing of the lines without any assistance whatsoever;

The Patient covenants and/or undertakes:

a) to use facilities at the Centre to dialyse himself on the allotted days and time as determined by SKS personnel at the Centre;

b) to follow strictly, the instruction of the SKS personnel on duty, especially with respect to use, maintenance, general order and cleanliness of the premises, machines, equipment and furnishing in or about the Centre.

c) not to extend his visit to the Centre beyond the allotted time as per appointment schedule;

d) to use the facilities at the Centre with care and skill;

e) to pay for any repairs or replacement of parts in respect of any damage of the dialysis machine or other equipment at the Centre caused by the Patient, whether willfully or as a result of neglect or failure to exercise care of skill;

4. The prescribed fee payable by the Patient weekly in advance on the first session of each week shall be calculated at the rate of Ringgit Malaysia ..................only per dialysis session.

PROVIDED ALWAYS that the SKS reserves to itself the right to vary the prescribed fee, written notice of which shall be given to the Patient.

5. The right to use the facilities at the Centre is personal to the Patient and for his sole benefit only, and the Patient shall not substitute, allow or assign this benefit to others;

6. The Patient shall be reviewed every six months by the SKS Dialysis Selection Committee and only upon the recommendation of SKS Dialysis Selection Committee, the Patient will be allowed to continue to use the facilities at the Centre.

7. If the Patient shall fail, to use the facilities on his schedule days and times for three consecutive occasions, the SKS reserves to itself the right to determine this Agreement forthwith without having to assign any reason therefore.

8. Notwithstanding Clause 7, the SKS reserves the right to terminate this Agreement by giving immediate notice to the Patient without assigning any reason and the Patient hereby agrees not to claim any compensation whatsoever against the SKS for any loss or damage suffered by the Patient pursuant to such termination.

9. If the Patient intends to cease using the facilities at the Centre, he shall give to the SKS a 30 day's written notice of his intention to do so.

10. The Patient hereby specifically agrees the right afforded to him in respect of the use of the facilities at the Centre is made on the basis that the SKS shall not be liable for any injury, loss or damage, whatsoever suffered by him and that he would not subject the SKS to any claim or compensation whatsoever.

11. The disbursements including stamping fees incurred in respect of the preparation of this Agreement shall be borne by the Patient.

12. In this Agreement wherever the context shall admit the male gender, it shall mean and include all the female and neuter gender.

13. The following terms used in the Agreement have the meaning shown as follows:

a) SKS Dialysis Selection Committee means The Committee appointed by the Sabah Kidney Society to organise, implement and manage the self care haemodialysis programme.

b) Treatment fee means the fee charged by the SKS to cover the operating cost of the Centre.

c) Doctor means a recognised physician, a nephrologist or a registered medical practitioner.

IN WITNESS WHEREOF the parties have hereto set their respective hands the day and year first above written.

 

 

SIGNED by the above named Patient ) In the presence of ) SIGNED by above Named Patient

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) -----------------------------------------------

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ) Name :

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) K/P :

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) Date :

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)

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SIGNED by . . . . . . . . . . . . . . . . . . . . . . . .

For and on behalf of the SKS . . . . . . . . . . . )

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )

In the presence of . . . . . . . . . . . . . . . . . . . . )

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) ---------------------------------------

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ). . . . . . . . .CHAIRMAN

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..) SABAH KIDNEY SOCIETY

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