ATTACHMENT E - PATIENT RIGHTS AND RESPONSIBILITIES.pdf
PDF 134 KB Posted
- Attached to
- Durable Medical Equipment Services
- Solicitation number
- 36C25626Q0301
About this file
This is Attachment E of a Department of Veterans Affairs contract document outlining Patient Rights and Responsibilities for prosthetic services and sensory aids.
The document establishes six primary patient rights: receiving appropriate, respectful, and courteous care; discussing concerns about service and device quality with VA staff; expressing concerns about service timeliness; discussing eligibility and entitlement to Prosthetic Services; maintaining privacy and declining participation in research studies; and refusing treatment or equipment to the extent permitted by law. Additional rights include completing and filing a Patient Satisfaction Form with questions and concerns, receiving timely written responses to complaints, appealing eligibility decisions directly to the Prosthetics Service, and appealing clinical and medical decisions directly to the Local VA Patient Advocate.
The document correspondingly establishes seven patient responsibilities: treating VA staff and contracted vendors/employees with respect and courtesy; taking reasonable safety precautions when using issued devices and appliances; exercising reasonable care and maintenance of equipment; immediately informing health care providers of defective or unnecessary equipment; prohibiting the sale, gifting, disposal, neglect, abuse, or unauthorized sharing of VA-provided equipment and devices; complying with prescribed care and treatment plans and communicating health care needs; and ensuring all VA-provided equipment and devices are properly moved when relocating residences. The document requires the veteran or caregiver to sign and date an acknowledgment confirming receipt and understanding of the document's content.
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Text version
PATIENT RIGHTS AND RESPONSIBILITIES (ATTACHMENT E)
As a 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 staff personnel.
5. Have privacy; to refuse to take part in any research studies.
2. Complete and have placed on file a copy of your 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 vendors/employees 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/CAREGIVER DATE
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