Exhibit B - Patient Rights and Responsibilities.pdf
PDF 117 KB Posted
- Attached to
- DME Services Federal contract opportunity
- Solicitation number
- 36C25624Q1457
About this file
This document is an Exhibit B titled "Patient Rights and Responsibilities" that outlines the rights and responsibilities of patients served by the Department of Veterans Affairs (VA) Prosthetic and Sensory Aids Service.
The key details are:
- Patients have the right to be treated with appropriate care, discuss concerns about service quality, express concerns about timeliness of services, discuss their eligibility and entitlement to Prosthetic Services, have privacy, refuse to participate in research studies, file a patient satisfaction form, receive a timely response to written complaints, and appeal decisions regarding their eligibility and entitlement to receive services.
- Patients have the responsibility to treat VA staff and vendors with respect, take reasonable safety precautions when using devices, exercise reasonable care and maintenance of devices, inform their provider when equipment is defective or no longer required, not sell or allow others to use VA-provided equipment, comply with their prescribed plan of care, and ensure VA-provided equipment is properly moved when relocating.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25624Q1457 0001 DME 12052024.pdf | ||
| Attachment 6 Bay County FL WD 2015-4559 R25 dtd 05-07-2024.pdf | ||
| Attachment 5 Mobile County AL WD 2015-4605 R22 dtd 05-08-2024.pdf | ||
| Attachment 3 Escambia County FL WD 2015-4561 R25 dtd 05-07-2024.pdf | ||
| Attachment 2 - Quality Assurance Surveillance Plan.pdf | ||
| 36C25624Q1457 DME.docx | DOCX document | |
| Exhibit C - Safety Checklist.pdf | ||
| Attachment 1 DME PWS Template 09032024.docx | DOCX document | |
| Attachment 4 Harrison County MS WD 2015-5147 R23 dtd 04-20-2024.pdf | ||
| Exhibit A - Delivery Checklist.pdf |
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Text version
Exhibit B
B-1 of 2
PATIENT RIGHTS AND RESPONSIBILITIES
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.
Exhibit B
B-2 of 2
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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