Subscription Form For Rapid Action Team Your name Last name Father's name D.O.B Your email Contact Total Family Member >123456 Family Name / Age /any operation in the past/ disease if any/last date of any investigations / Current Medications 1 2 3 4 Details of any serious illness if suffered in the past Building / Society Address city Pin State Services: - We are going to provide the fastest emergency medical services at your door step using tele medicine. To ensure this its expected from all the subscribers to keep an emergency kit with themselves as suggested by our team. This kit will have BP instrument, Glucometer, Pulse Oximeter, Thermometer Nebuliser and some emergency medicines depending on the health and disease of the family members. In any medical emergency, first call will be always attended by an ICU consultant directly so that the basic treatment for the emergency is started immediately with the help of emergency kit already available in the house. In the mean time Rapid Action Team comprising of Paramedics and Smart ICU Ambulance will be activated to reach the patient within the time frame of ten minutes. This Rapid Action Team will also consist of Riders who are also going to be trained paramedics and will give cover to our Ambulance Team. Paramedics will connect with the ICU Consultant team through e technology and will start the treatment as guided by consultant for the emergency care. Our team will try to provide the best of the emergency treatment at home but if patient needs to be shifted to a hospital for further management, our team will shift the patient to the hospital as per the choice of the family members. The cost at the hospital is to be borne by the patient /relatives. This shifting of the patient is going to be directly under the supervision of the ICU consultant. The ICU consultant is going to monitor the patient throughout the journey/ evacuation. Cost of the services- Annual Subscription charges-Rs18000/Family up to 4, Emergency Call-Rs1500/Call This subscription charge of Rs18000 is valid only for those registered with us till February 15th 2025, the charges for subscription will be Rs30000/family from the 15th February and the emergency call is going to be Rs2500/Call for new members after 15th February 2025. The subscription amount can be paid by PDC dated 31st January 2025 in the favour of QA VIRTUAL HEALTH CARE PRIVATE LIMITED which will be collected by our team or it can be paid directly through the QR code given at the bottom of the form. Emergency Call- 1.Consultation with an ICU consultant 2.Bed side basic emergency investigations like ECG, Trop T and Blood Sugar 3.Bed side emergency management(Medicines to be replaced) 4.Evacuation to a higher center in the radius of 100kms. Non Subscribers & Guest for the family. The Non Subscribers have to pay Rs20000/Emergency call. Date of start of our Services-15th February 2025. The unique subscription ID and other details will be shared over to the subscriber before 15th of February 2025. I Agree With Above Mentioned Terms & Conditions Δ Name Father's Name Date Of Birth Email Contact No- Total Family Member Family Name / Age /any operation in the past/ disease if any/last date of any investigations / Current Medications Details of any serious illness if suffered in the past Building / Society Address City Pin State Services : - We are going to provide the fastest emergency medical services at your door step using tele medicine. To ensure this its expected from all the subscribers to keep an emergency kit with themselves as suggested by our team. This kit will have BP instrument, Glucometer, Pulse Oximeter, Thermometer Nebuliser and some emergency medicines depending on the health and disease of the family members. In any medical emergency, first call will be always attended by an ICU consultant directly so that the basic treatment for the emergency is started immediately with the help of emergency kit already available in the house. In the mean time Rapid Action Team comprising of Paramedics and Smart ICU Ambulance will be activated to reach the patient within the time frame of ten minutes. This Rapid Action Team will also consist of Riders who are also going to be trained paramedics and will give cover to our Ambulance Team. Paramedics will connect with the ICU Consultant team through e technology and will start the treatment as guided by consultant for the emergency care. Our team will try to provide the best of the emergency treatment at home but if patient needs to be shifted to a hospital for further management, our team will shift the patient to the hospital as per the choice of the family members. The cost at the hospital is to be borne by the patient /relatives. This shifting of the patient is going to be directly under the supervision of the ICU consultant. The ICU consultant is going to monitor the patient throughout the journey/ evacuation. Cost of the services- Annual Subscription charges-Rs18000/Family up to 4, Emergency Call-Rs1500/Call This subscription charge of Rs18000 is valid only for those registered with us till February 15th 2025, the charges for subscription will be Rs30000/family from the 15th February and the emergency call is going to be Rs2500/Call for new members after 15th February 2025. The subscription amount can be paid by PDC dated 31st January 2025 in the favour of QA VIRTUAL HEALTH CARE PRIVATE LIMITED which will be collected by our team or it can be paid directly through the QR code given at the bottom of the form. Emergency Call- 1.Consultation with an ICU consultant 2.Bed side basic emergency investigations like ECG, Trop T and Blood Sugar 3.Bed side emergency management(Medicines to be replaced) 4.Evacuation to a higher center in the radius of 100kms. Non Subscribers & Guest for the family. The Non Subscribers have to pay Rs20000/Emergency call. Date of start of our Services-15th February 2025. The unique subscription ID and other details will be shared over to the subscriber before 15th of February 2025. I Agree With Above Mentioned Term & Conditions Submit
