Pulse Oximeter Request Form

Our Safe Surgery Initiative aims to improve access to safe surgery in low-resource settings using volunteer surgery teams like yours to place pulse oximeters and to train health care workers on their use for perioperative patient monitoring.

If approved, you are required to leave the donated pulse oximeters at your in-country facility so that they can be used year-round, regardless of the presence of a visiting medical team.

  • You will be eligible to receive donated units and probes to be left with your in-country partner, if you or your in-country partner:

  • MM slash DD slash YYYY
    * To be eligible, you must have an upcoming medical trip.
  • * HCP must be personally traveling to the destination country, account for the disposition of the donated products, possess current U.S. license to practice and prescribe independently.
  • * If different than Health Care Provider
  • *The person who will accept responsibility for the pulse oximeters.

  • As part of the Safe Surgery Initiative, Americares will be contacting the in-country contact regarding the use of the oximeters.

    By selecting the “Submit” button, you are confirming that you have reached out to the in-country recipient and have their permission to share their contact information to Americares.

  • Thank you. We are grateful for your cooperation and excited about working with you.
  • This field is for validation purposes and should be left unchanged.

Medical Outreach Photo Releases

We ask that you take Americares photo release forms with you on your trip and ask patients to sign a release form acknowledging their consent. When photographing pediatric patients, a parent or legal guardian must sign on behalf of the child.

Photographs from the field play a key role in Americares work. They help us make a compelling case to donors who contribute medical products and funding.

Tip: Upload your photo releases as a pdf or .jpeg along with your photos when completing your post trip field report

Download the Photo Release Form