STATEMENT OF PATIENT RIGHTS
As a patient of Total Knee Accelerated Recovery DME, LLC. (also referred to as “Organization”), the following rights are afforded to you and your caregiver:
• Be fully informed in advance about care/service to be provided, including the disciplines that furnish care and the frequency of visits, as well as any modifications to the plan of care
• Be informed, both orally and in writing, in advance of care being provided, of the charges, including payment for care/service expected from third parties and any charges for which the client/patient will be responsible
• Receive information about the scope of services that the organization will provide and specific limitations on those services
• Participate in the development and periodic revision of the plan of care
• Refuse care or treatment after the consequences of refusing care or treatment are fully presented (Patient has the right to refuse the products supplied)
• Be informed of client/patient rights under state law to formulate an Advanced Directive
• Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.
• Be able to identify visiting staff members through proper identification (Identification of provider to the beneficiary is their photo or personal identification badge).
• Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of client/patient property
• Voice grievances/complaints regarding treatment or care or lack of respect of property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal
• Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lack of respect of property investigated
• Confidentiality and privacy of all information contained in the client/patient record and of Protected Health
• Be advised on agency’s policies and procedures regarding the disclosure of clinical records
• Choose health care provider, including choosing an attending physician
• Receive appropriate care without discrimination in accordance with physician orders
• Be informed of any financial benefits when referred to an organization
• Be fully informed of one’s responsibilities
• Be fully informed orally and in writing of your rights and responsibilities
• Be informed, both orally and in writing, in advance of:
• Items and services furnished by (or under arrangements with) Organization for which payment may be made
• Charges for non-covered items or services, furnished by (or under arrangements with) Organization, the
amount you may have to pay, and changes in these charges or items and services for which you may be liable.
• Coverage available for items and services under Medicare, Medicaid, any other Federal program, or thirdparty
of which Organization is reasonably aware.
• The right to receive an explanation of forms that you are requested to sign
The client has a right to refuse care, equipment, or services. Total Knee Accelerated Recovery DME, LLC staff shall
explain consequences of this refusal to the client, but shall not threaten or force treatment on the client in any way.
Further, any staff member may request to be excused from participating in any aspect of care, treatment, or services to aclient, and Organization management staff shall ensure that client care is not adversely impacted due to this request.
The client who feels that his/her rights have been denied, desires further clarification of rights or who desires to lodge a complaint about any aspect of service or care should contact the Administrator or other supervisory staff verbally or in writing. The Organization’s grievance procedures will be followed in handling grievances and complaints.
If you feel your complaint has not been resolved, you may also contact the Accreditation Commission for Health Care
(ACHC) by the following ways:
• Online: www.achc.org (Click on “Contact” and then choose “Complaints”)
• E-mail: firstname.lastname@example.org
• Phone: 855-937-2242
• Fax: 919-785-3011
• Mail: Accreditation Commission for Health Care
139 Weston Oaks Ct.
Cary, NC 27513
The Organization has the right to expect behavior from the client/caregiver(s) that is reasonable and responsible within the constraints of the illness or debility. Clients have the following responsibilities to the Organization:
• Providing accurate information about their medical condition and past medical history, and reporting changes in
their condition immediately.
• Asking questions when they do not understand their care, equipment, or proper usage.
• Following the instructions for equipment usage as set forth by Organization and their physician, and reporting to
Organization their concerns about their ability to follow such instructions.
• Accepting the consequences if they do not follow the instructions for proper usage and maintenance of their
• Following the Organization’s rules and regulations.
• Showing respect and consideration for Organization staff and their property.
• Meeting financial commitments agreed to with Organization.