14.EXHIBIT 2 – 36C25625Q0722 VETERAN PATIENT RIGHTS AND RESPONSIBILITIES.pdf
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- Solicitation number
- 36C25625Q0722
About this file
Exhibit 2 is a Veteran Patient Rights and Responsibilities document that outlines the rights and responsibilities of veterans receiving services from the Department of Veterans Affairs (VA). The document details six specific patient rights, including being treated with respect, discussing service quality and concerns, expressing views on service timeliness, discussing prosthetic service eligibility, maintaining privacy, and having the ability to appeal decisions. The document also enumerates seven patient responsibilities, which include treating VA staff courteously, taking safety precautions with issued devices, maintaining equipment, informing healthcare providers about equipment issues, and complying with prescribed care plans. The document concludes with signature lines for the veteran patient/caregiver and a delivery person to acknowledge receipt and understanding of the rights and responsibilities.
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EXHIBIT 2 – VETERAN PATIENT RIGHTS AND RESPONSIBILITIES
As a Veteran patient served by the Department of Veterans Affairs, you have the Right to:
1. Be treated with appropriate, considerate, respectful, and courteous care.
2. Discuss with our staff your concerns or issues pertaining to the quality of service and/or devices furnished to you.
3. Express your concerns regarding the timeliness of services and devices provided.
4. Discuss your eligibility and entitlement to Prosthetic Services with VAMC.
5. Have privacy; to refuse to take part in any research studies.
2. Complete and have placed on file a copy of your Veteran Patient Satisfaction Form, clearly stating your questions and concerns.
3. Receive a response to a written complaint in a timely manner.
4. Appeal directly to the Prosthetics Service, any decision made by your local Prosthetics & Sensory Aids
Service, concerning your eligibility and entitlement to receive such services.
5. Appeal directly to the Local VA Patient Advocate, any decision made by your VA health care provider, concerning medical/clinical criteria, eligibility, and entitlement to receive such services.
6. Refuse treatment/equipment to the extent permitted by law.
As a patient served by the Department of Veterans Affairs, you have the Responsibility to:
1. Treat the VA staff and contracted personnel with respect and courtesy.
2. Take reasonable safety precautions when using devices and/or appliances issued to you.
3. Exercise reasonable care and maintenance of devices and appliances issued to you.
4. Immediately inform your health care provider when equipment is defective or is no longer required for use.
5. Not sell, give away, dispose of, neglect/abuse, or allow others to use equipment/devices provided to you by the Department of Veterans Affairs as part of your prescribed plan of care/treatment.
6. Comply with the prescribed plan of care/treatment and to communicate any concerns and health care needs with your health care provider(s).
7. Ensure all equipment/devices, provided to you as part of your prescribed plan of care/treatment, are personally/properly moved, along with other personal household items/ furnishings, when relocating to a new residence.
I HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THE PATIENT’S RIGHTS AND RESPONSIBILITIES DOCUMENT. I
HAVE REVIEWED AND UNDERSTAND THE CONTENT OF THE DOCUMENT.
SIGNATURE OF VETERAN PATIENT/CAREGIVER DATE
DELIVERY PERSON’S SIGNATURE DATE
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