RISK BOND FOR AMBULANCE TRANSPORT

My patient named__________ aged____________ discharged from Bangladesh

specialized hospital, cabin/bed:____ and want to go _______________Or
wants to come to Bangladesh specialized hospital for_____________ from home
located in ____________________________. During transport my patient can
deteriorate and will get tried for all existing available and limited support from
ambulance.
Despite if anything happens to my patient, hospital or ambulance service will not
be responsible.

1. Name:
Relation with patient:
Signature:
2. Name:
Relation with patient
Signature: