HCA of PALM BEACH, INC.
HOMECARE AMERICA
PATIENT BILL of RIGHTS
Homecare America will inform the patient/client of the following:
1 The products and services that will be furnished.
2 Any changes in products or services.
3 Patient rights and responsibilities for participation or refusal of care and services.
4 The schedule and procedures that will be followed in providing the products and services,including the frequency of the home visits, with the expected time frames for receipts of delivered items.
5 Options for rental versus purchase for equipment and supplies (when applicable), includingassociated costs.
6 Time when rental items converts to purchase (when applicable)
7 Policies for after and emergency coverage.
8 Essential contact information for repairs, emergencies, and customer service.
Homecare America respects thepatient’s/client’s need for confidentiality, privacy, and security, and allstaff will specifically:
1 Respect the patient’s/client’s right to personal privacy when services are rendered.
2 Respect the patient’s/client’s personal property and security during home visit.
Homecare America will:
1. Provide clean equipment in good repair when equipment is rented to you.
2. Efficiently resolve any problem or complaint you may encounter
3. Answer your questions and resolve any concern quickly and accurately.
YOU HAVE THE RESPONSIBILITY TO:
1. Give accurate and complete information regarding your insurance coverage.
2. Inform us promptly changes to your coverage
3. Assist in developing maintaining a safe environment
4. Follow instructions related to the care and use of the equipment we have provided
5. Treat Homecare America staff with respect and courtesy
6. Reorder supplies within a timely basis to allow for a reasonable delivery turnaround
7. Have someone home when a delivery or service is scheduled
8. Pay all invoices when due or not covered by your insurance
9. Accept the consequences for any refusal or choice of non-compliance, including changes inreimbursement eligibility.
Obtain a paper copy of the Notice upon request. You may request a copy of our current Notice at anytime by contacting our office at 17380 N HIGHWAY ALT. A 1 A, JUPITER, FL. 33477OR TELEPHONE AT
561-741-0444.
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use and disclosure of your PHI by sending a written request to our office. We are not required to agree to those restrictions. We cannot agree to restrictions on uses or disclosures that are legally required, or which are necessary to administer our business.
Inspect and obtain a copy of your PHI. In most cases, you have the right to access and copy the PHI that we maintain about you. To inspect or copy your PHI, you must send a written request to our office. We may charge you a fee for the costs of copying, mailing, and supplies that are necessary to fulfill your request. W emay deny your request to inspect and copy in certain circumstances.
Request an amendment of PHI. If you feel the PHI we maintain about you isincomplete or incorrect, you may request that we amend it. To request anamendment, you must send a written request to our office. You must include areason that supports your request. In certain circumstances, we may deny yourrequest for amendment.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting we have made of your PHI after April 14, 2003, for most purposes other than treatment, payment, or health care operations. This right is subject to certain exceptions, restrictions, and limitations. To request an accounting, you must submit a written request to our office. Your request must specify the time period. The time period may not be longer than six years and may not include dates before April14, 2003.
Request communication of PHI by alternate means or at alternate locations. For example, you may request that we contact you at a different residence or post office box. To request confidential communication of your PHI, you must submit a written request to our office. Your request must tell us how or where to contact you.We will accommodate all reasonable requests.
Incidental disclosures. An example of incidental disclosure is conversations that may be overheard between you and a member of our staff. HOMECARE AMERICA will make reasonable efforts to avoid incidental disclosures of protected health information.
For more information or to report a problem. If you have questions or would like additional information about OUR privacy practices, you may contact our office at 17380 NHWY ALT. A 1 A JUPITER, FL 33477 or telephone at 561-741-0444.. If you believe your privacy rights have been violated, you can file a complaint with our office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Effective date.This Notice is effective as of January 01, 2023.
Equipment Warranty Information Form
Every product sold or rented by our company carries a 1-year manufacturer’s warranty.Homecare America of Palm Beach, Inc., will notify all Medicare beneficiaries of the warrant coverage, and we will honor all warranties under applicable law. Homecare America of Palm Beach, Inc., will repair or replace, free of charge, Medicare covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for all durable medical equipment where this manual is available. I have been instructed and understand the warranty coverage on the product I have received.
MEDICARE DME POS SUPPLIER STANDARDS
The products and/or services provided to you by HCA of PALM BEACH, INC are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal RegulationsSection 424.57(c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Upon request we will furnish you a written copy of the standards.
