Hospital Report Instructions

HOSPITAL REPORT INSTRUCTIONS

Only those activities that involve service to, visits to, the loan of equipment to or the donation of items listed on the reverse side, to live veterans are reported on this form. That includes those veterans in VA, military and other hospitals, nursing homes, shut-ins, the impoverished and the homeless. This report is submitted to the Department of Arizona Hospital Chairman.. Send this report to: Bob & Debi Rankin [email protected] 1840 S Pinto Drive Apache Jct, AZ 85220 480.982.0648 F: 480.968.7990

REPORT PERIOD: Month Year

VFW/LAVFW, STATE OF AZ DISTRICT# POST / Aux #

LIST PROJECTS BELOW: (P=Post, A=Aux, O=Other Unit; Circle as appropriate) Number Number Persons Patients or Projects DESCRIPTION Participated Total Total Donations or Persons Complete Hours Miles Services Benefited

Pints of Blood Donated P O A @ $69.99/Pint

P O A Home Visits Completed

P O A Veterans Transported P O A Hospital Visits

P O A Care Center/Nursing Home Visitations P O A Military Hospital Visits P O A VA Hospital Visits

P O A Life Care/Senior Care Visits

Multiplied X $12.84 $00.14

Hospital Equipment Loaned (Total Value)

Each Column TOTALS

SIGNED BY: Additional Comments: TITLE: CHECKED BY: DISTRICT # DEPARTMENT OF ARIZONA REPORT TOTAL VALUATION: $ “Hospital Report” Instructions

Only those activities that involve service to, visits to, the loan of equipment to or the donation of items listed below to live veterans are reported on this form. That includes those veterans in VA, military and other hospitals, nursing homes, shut-ins, the impoverished and the homeless. This report is submitted to the Department of Arizona Hospital Chairman. Send this report to: Bob & Debi Rankin [email protected] 1840 S Pinto Drive Apache Jct, AZ 85220 480.982.0648 F: 480.968.7990

NOTE: Funerals are reported on the Chaplains Report”, which is submitted to the State Chaplain. Helping veterans or their widows receiving benefits is reported on the “Service Officer Report”, which is submitted to the State Service officer. Type or print legibly in ink. Prepare in duplicate: One for the Post File, one sent to the Department of Arizona Hospital Chairman. Fill in the Post Number, the District Number and the dates covered by this report. Type or print legibly the name of the person submitting this Report, the person’s Post Title and the date the Report is prepared. If your descriptions of your “Project” will not fit in the “Description” column, simply place a numeral in the box and, on a separate sheet of paper, write the corresponding number followed by your description of the Project. Under “Name of Facility” for “Hospital Visits” indicate the name of the Hospital, Nursing Home or the shut-in’s name. In the “Service Value” section, indicate the number of hours volunteered, total miles traveled, the number of blood donations given, etceteras, in the column marked “multiplicand”. Multiply that number by the dollar amount shown in the “Multiplier” column to arrive at the amount in the “Dollar Value” column. Add the amounts in the “Dollar Value” column to arrive at the “Total Value of Report”.

CREDIT VALUES FOR “LOANED HOSPITAL EQUIPMENT” CREDIT VALUES FOR “DONATED CLOTHING” (Actual Price for Purchased Items) Crutches (Canadian) (per month) $ 21.95 Crutches (Regular) (per month) $ 20.00 Men’s Women’s Hospital Bed (Electric) (per month) $ 190.00 Bathrobe $ 5.00 $ 5.00 Hospital Bed (Regular) (per month) $ 70.00 Belt $ 2.00 $ 2.00 Potty Chair (per month) $ 24.00 Dress N/A $ 8.00 Walker (per month) $ 21.95 Jacket/Coat $10.00 $10.00 Wheel Chair (per month) $ 53.50 Pajamas/Nightgown $ 3.00 $ 3.00 Shirt/Blouse $ 3.00 $ 1.50 Shoes $ 2.00 $ 2.00 Skirt N/A $ 5.00 CREDIT VALUES FOR “OTHER DONATIONS” Sweater $ 4.00 $ 4.00 Trousers/Jeans/Slacks $ 5.00 $ 3.50 Bed Jacket $ 34.50 Books & Magazines (new) Cost CREDIT VALUES FOR “DONATED FOOD” Books & Magazines (used) 1/2 Cost (Actual Price for Purchased Items) Flower Vase Small $ 1.00 Brownies (per dozen) $ 6.00 Medium $ 2.00 Cake Large $ 3.00 Plain $ 5.00 Jigsaw Puzzle $ 2.00 Decorated $ 6.00 Knitted Cap $ 5.00 Candy (per pound) $ 6.00 Knitted Slippers $ 10.00 Cookies Lap Robe, Knitted Plain (per dozen) $ 4.50 Small 24” x 32” $ 40.00 Decorated (per dozen) $ 6.00 Medium 36” x 40” $ 56.00 Cupcakes Large 48” x 48” $ 66.00 Plain (per dozen) $ 4.00 Lap Robe, Patchwork $ 34.50 Decorated (per dozen) $ 6.00 Long Slipper Bed Socks $ 12.00 Deviled Eggs (per dozen) $ 5.00 Pillow Fruit Bread (per loaf) $ 5.00 Medium 10” x 10” $ 7.00 Jell-O Large 12” x 12” $ 8.50 Plain (per gallon) $ 3.00 Playing Cards $ .50 with Fruit (per gallon) $ 5.00 Shoulder Stole $ 20.00 Pie (each) $ 5.50 Wheel Chair Caddie $ 10.00 Salad (per gallon) $ 5.00 Wheel Chair Cushion $ 12.00 Sandwich (each) $ 2.00