Exhibit B Patient Rghts and Responsibilities.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25625R0109
About this file
The document is a Patient Rights and Responsibilities exhibit for the Department of Veterans Affairs Prosthetic Services. It outlines ten patient rights, including receiving respectful care, discussing service concerns, expressing service timeliness issues, privacy, filing complaints, and appealing service decisions. Corresponding patient responsibilities include treating VA staff with courtesy, taking safety precautions with medical devices, maintaining equipment, reporting defective items, not misusing provided equipment, and complying with prescribed treatment plans.
The related federal contract opportunity is a Set-Aside Service-Disabled Veteran-Owned Small Business (SDVOSB) Request for Quote (RFQ) for Durable Home Medical Equipment Accessories Services at the Alexandria Veterans Health Care System. The solicitation (36C25625R0109) seeks a firm-fixed price contract for DME/HME services, with technical questions due by 2:30 PM CDT on 06/25/2025 and offer submissions due by 2:30 PM on 06/27/2025. Interested vendors must be registered in SAM and certified through SBA's VetCert program, with work to be performed at the Alexandria VA Healthcare System in Pineville, Louisiana.
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Other files
| File | Type | Posted |
|---|---|---|
| S06 - 36C25625R0109 0001.pdf | ||
| 36C25625R0109 0001_1.docx | DOCX document | |
| Attachment 2 QASP.pdf | ||
| Exhibit A Delivery Checklist.docx | DOCX document | |
| 36C25625R0109.pdf | ||
| Exhibit C Safety Checklist.docx | DOCX document | |
| 36C25625R0109_1.docx | DOCX document | |
| Attachment 1 PWS- Alexandria DME.pdf | ||
| Attachment 3 Conbined WDs 2015-5175 5183 5197 5209.pdf |
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Text version
PATIENT RIGHTS AND RESPONSIBILITIES (Exhibit 2)
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.
6. Complete and have placed on file a copy of your Patient Satisfaction Form, clearly stating your questions and concerns.
7. Receive a response to a written complaint in a timely manner.
8. 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.
9. 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.
10. 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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