Bill of Patient Rights and Responsibilities

As an individual receivingservices from the provider, you are entitled to:

  • Be fully informed in advance about care/service to be provided, including the disciplines that furnish care and the frequency of visits, as well as any modifications to your plan of care.
  • Be informed, in advance of care/service being provided and your financial responsibility.
  • Receive information about the scope of services that the organization will provide and specific limitations on those services.
  • Participate in the development and periodic revision of your plan of care.
  • Refuse care or treatment after the consequences of refusing care or treatment are fully presented.
  • Be informed of client/patient rights under state law to formulate an Advanced Directive, if applicable.
  • Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.
  • Be able to identify visiting personnel members through proper identification.
  • Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of client/patient property.
  • Voice grievances/complaints regarding treatment or care or lack of respect of property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal.
  • Have grievances/complaints regarding treatment of care that is (or fails to be) furnished, or lack of respect of property investigated.
  • Confidentiality and privacy of all information contained in your client/patient record and of Protected Health Information (PHI).
  • Be advised on the provider’s policies and procedures regarding the disclosure of clinical records.
  • Choose a healthcare provider, including an attending physician*, if applicable.
  • Receive appropriate care without discrimination in accordance with physician’s* orders, if applicable.
  • Be informed of any financial benefits when referred to an organization.
  • Be fully informed of one’s responsibilities.

*a physician or other licensed practitioner with prescribing authority.

Your Responsibilities, you agree:

  • That rental equipment will be used with reasonable care, not altered, or modified and returned in good condition (normal wear and tear expected), if applicable
  • To report any malfunctions or defects in rental equipment immediately so that repair or replacement can be made, if applicable.
  • To provide access to rental equipment for repair/replacement or pick up, if applicable.
  • To utilize equipment provided in accordance with your physician’s orders.
  • To keep rental equipment at the location given at the time of rental and not to remove it to any other location unless authorized by the provider, if applicable.
  • To notify provider immediately of any hospitalizations, change in address, insurance, telephone #, or physician information, or if you do not need the equipment any longer, if applicable.
  • To sign an assignment of benefit for all insurance payers to provider.
  • To accept financial responsibility for HME/supplies provided as allowed by insurance carrier.
  • To pay replacement cost of any equipment damaged, destroyed, or lost due to misuse, abuse, or neglect.
  • Not to modify rental equipment, if applicable.
That the title of rental equipment remains with the provider until such time the equipment is purchased and paid in full. That provider shall not insure or be responsible to you for any personal injury, or property damage related to any equipment; including that caused by use or improper functioning of the equipment; the act or omission of any other third party, or by any criminal act or activity, war, riot, fire or act of God. That the provider retains the right to refuse delivery of service/equipment at any time.