Patient Rights Responsibilities.docx

PATIENT RIGHTS & RESPONSIBILITIES

RIGHTS:

As a patient of the VA Facility, you have the right to the following:

· To be treated with respect and courtesy.

· To discuss with our staff your concerns or issues pertaining to the quality of services and/or devices furnished to you.

· To express your concerns regarding the timeliness of service and devices provided.

· To discuss your eligibility and entitlement of prosthetic services with our staff.

· To complete and have placed on file a copy of your Patient Satisfaction Form clearly stating your questions and concerns.

· To receive a response to a written complaint in a timely manner.

· To appeal any decision made by the Prosthetic and Sensory Aids Service concerning your eligibility and entitlement to receive such services.

RESPONSIBILITIES:

As a patient of the VA Facility, you have the responsibility to the following:

· To treat the staff of the Prosthetic and Sensory Aids Service with respect and courtesy.

· To take reasonable care when using devices and/or appliances issued to you.

· To immediately advise the Prosthetic and Sensory Aids Service of defective equipment.

· To advise the Prosthetic and Sensory Aids Service when equipment is no longer required for your use.

· To NOT sell or give away any equipment provide to you by the VA facility.

· To exercise reasonable care and maintenance of devices and appliances that were issued to you.

Veteran’s Name: ______________________________________________________________________ Veteran’s Signature: ___________________________________________________________________ Date: _______________________________________________________________________________ image1.png