3322 N. Milwaukee Ave
Chicago, IL 60641
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Tel: (773) 205-6993
Fax: (773) 205-6994
Advanced Medical Supply, Inc is accredited with a Gold Seal of Approval by the Joint Commission Accreditation Program
Client/Patient Bill of Rights and
Responsibilities
We believe that all clients receiving services from Advanced Medical Supply, Inc should be informed of their rights. Therefore, as a client of Advanced Medical Supply, Inc you are entitled to:
1. Receive reasonable coordination and continuity of services from the referring agency for home medical equipment services.
2. Receive a timely response from Advanced Medical Supply, Inc when homecare services/care is needed or requested.
3. Be fully informed in advance about service/care to be provided and any modifications to the Plan of Service/Care.
4. Participate in the development and periodic revision of the Plan of service/care.
5. Informed consent and refusal of service/care or treatment after the consequences of refusing service/care or treatment are fully presented.
6. Be informed in advance of the charges, including payment for service/care expected from third parties and any charges for which the client/patient will be responsible.
7. Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.
8. Be able to identify visiting staff members through proper identification.
9. Voice grievances/complaints or recommend changes in policy, staff or service/care without restraint, interference, coercion, discrimination or reprisal.
10. Choose a health care provider.
11. Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information.
12. Receive appropriate service/care without discrimination in accordance with physician orders.
13. Be informed of any financial benefits when referred to an organization.
14. Be fully informed of one’s responsibilities.
15. Be informed of provider service/care limitations.
16. Be informed of client/patient rights under state law to formulate advance care directives.
17. Be informed of anticipated outcomes of service/care and of any barriers in outcome achievement.
18. Receive reasonable coordination and continuity of services from the referring agency for home medical equipment services
19. Receive a timely response from Advanced Medical Supply, Inc when homecare services or care are needed or requested
20. Be fully informed in advance about service or care to be provided, and any modifications to the Plan of Service or the Plan of Care
21. Participate in the development and periodic revision of the Plan of Service or the Plan of Care
CLIENT RESPONSIBILITIES
1. Client agrees that rental equipment will be used with reasonable care, not altered or modified, and returned in good condition (normal wear and tear excepted).
2. Client agrees to promptly report to Advanced Medical Supply, Inc any malfunctions or defects in rental equipment so that repair/ replacement can be
arranged.
3. Client agrees to provide Advanced Medical Supply, Inc access to all rental equipment for repair/replacement, maintenance, and/or pick-up of the equipment.
4. Client agrees to use the equipment for the purposes so indicated and in compliance with the physician’s prescription.
5. Client agrees to keep the equipment in their possession and at the address, to which it was delivered unless otherwise authorized by Advanced Medical Supply, Inc
6. Client agrees to notify Advanced Medical Supply, Inc of any hospitalization, change in customer insurance, address, telephone number, physician, or when the medical need for the rental equipment no longer exists.
7. Client agrees to request payment of authorized Medicare, Medicaid, or other private insurance benefits are paid directly to Advanced Medical Supply, Inc for any services furnished by Advanced Medical Supply, Inc.
8. Client agrees to accept all financial responsibility for home medical equipment furnished by Advanced Medical Supply, Inc
9. Client agrees to pay for the replacement cost of any equipment damaged, destroyed, or lost due to misuse, abuse or neglect.
10. Client agrees not to modify the rental equipment without the prior consent of Advanced Medical Supply, Inc
11. Client agrees that any authorized modification shall belong to the titleholder of the equipment unless equipment is purchased and paid for in full.
12. Client agrees that title to the rental equipment and all parts shall remain with Advanced Medical Supply, Inc at all times unless equipment is purchased and paid for in full.
13. Client agrees that Advanced Medical Supply, Inc shall not insure or be responsible to the client for any personal injury or property damage related to any equipment; including that caused by use or improper functioning of the equipment; the act or omission of any other third party, or by any criminal act or activity, war, riot, insurrection, fire or act of God
14. Client understands that Advanced Medical Supply, Inc retains the right to refuse delivery of service to any client at any time.
15. Client agrees that any legal fees resulting from a disagreement between the parties shall be borne by the unsuccessful party in any legal action taken.
When the client/patient is unable to make medical or other decisions, the family should be consulted for direction.
All staff members will understand and be able to discuss the Client Bill of Rights and Responsibilities with the client/patient and caregiver(s). Each staff member will receive training during orientation and attend an annual in-service education class on the Client Bill of Rights and Responsibilities.
