Exhibit B Patient Rights and Responsibilities.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25626R0016
About this file
The document is an Exhibit detailing Patient Rights and Responsibilities for the Department of Veterans Affairs Prosthetic Services. The document outlines ten patient rights, including being treated with respect, discussing service concerns, expressing service timeliness issues, having privacy, receiving responses to complaints, and appealing decisions. Correspondingly, it also lists seven patient responsibilities, such as treating VA staff courteously, taking safety precautions with issued devices, maintaining equipment, reporting defective items, not misusing equipment, complying with treatment plans, and ensuring proper equipment relocation. The document concludes with a signature acknowledgment section for veterans or caregivers to confirm understanding and receipt of the rights and responsibilities.
This patient rights exhibit is directly related to the Federal Contract Opportunity (Solicitation Number 36C25626R0016) for Durable Home Medical Equipment Accessories Services at the Alexandria VA Healthcare System. The solicitation is a Small Business Set-Aside Request for Quote (RFQ) for a firm-fixed price contract. Specific details include: performance location in Pineville, LA; technical questions due by 3:00 PM CDT on 11/03/2025; offer submissions due by 3:00 PM on 11/07/2025; and a requirement for offerors to be registered in SAM and certified as Service-Disabled Veteran-Owned Small Businesses (SDVOSBs).
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25626R0016 0002_1.docx | DOCX document | |
| S06 - 36C25626R0016 0002.pdf | ||
| 36C25626R0016 0001_1.docx | DOCX document | |
| S05 - Technical Questions 36C25626R0016 .pdf | ||
| S02 - 36C25626R0016 Updated.pdf | ||
| S06 - 36C25626R0016 0001.pdf | ||
| Attachment 3 Conbined WDs 2015-5175 5183 5197 5209.pdf | ||
| Attachment 1 Performance Work Statement.pdf | ||
| 36C25626R0016.pdf | ||
| Exhibit C Safety Checklist.docx | DOCX document | |
| Exhibit A Delivery Checklist.docx | DOCX document | |
| Attachment 2 QASP.pdf | ||
| 36C25626R0016_1.docx | DOCX document |
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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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