CUSTOMER BILL OF RIGHTS

1. To be fully informed of your rights and responsibilities through effective means of communication before receiving any home health care service and to exercise these rights.  Your family or legal representative may exercise your rights as permitted by law.  A written notice of the customer’s rights will be provided before initiation of care.
   
2. To participate in the planning of your home health care and treatment and to be informed, in advance, of changes in your care including a 5-day discharge notice in accordance with federal and state regulations unless waived by law.  As a participant in your care, you have the right to know what services you are to receive, and how often you are to receive them and the right to make decisions about your medical care including the right to accept or refuse care.
   
3. To form Advance Directives, which direct your care.  The administering of care to you will not be affected by whether you have or don't have advance directives in place.
   
4. To maintain confidential clinical records and for the agency to safeguard your Protected Health Information in accordance with the Health Insurance Portability and Accountability Act unless waived by law.
   
5. To access your Protected Health Information.  When requesting copies of Protected Health Information, a $0.25 charge per page will be assessed plus postage and handling.  To request access to your Protected Health Information, contact the Privacy Officer at the phone number listed below.
   
6. To be informed of the agency’s policies on disclosure of medical information and how the agency will use and disclose your Protected Health Information.  Use and disclosure of Protected Health Information is described in the VNP Notice of Privacy Practices.  Disclosure of Protected Health Information not described in the VNP Notice of Privacy Practices shall be authorized by you or your legal representative unless waived by law.
   
7. To have your property treated with respect and dignity, and to be free from verbal, physical, and psychological abuse.
   
8. To participate in the consideration of ethical issues arising in your care.
   
9. To voice grievances without fear of discrimination or reprisal about your treatment or care that is (or fails to be) furnished or regarding the lack of respect for property by anyone who is furnishing services on behalf of the agency.  You may inform the agency of such concerns in writing or by telephone by contacting the Privacy Officer listed below.
   
10. To know about the disposition of such complaints.  The agency will investigate complaints made by a customer or customer’s legal representative regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the customer’s property by anyone furnishing services on behalf of the agency.  The agency will document the existence of the complaint and the resolution of the complaint.
    
11. To be informed of the availability of the state home health agency hot line to lodge complaints concerning the implementation of the Advance Directives requirements or regarding treatment or care that is (or fails to be) furnished by the home health agency.  IN INDIANA CALL: 1-800-227-6334.  This number is available 24 hours/day, 7 days a week for filing complaints or making inquiries.  Voice mail is available after hours and on holidays and weekends.
    
12. To be informed of the charges for which you may be liable.  You have the right to receive this information orally and in writing, within thirty working days of the date the agency becomes aware of any changes in charges.  You have the right to have access, upon request, to all bills for service you have received regardless of whether they are paid out-of-pocket or by another party.
    
13. You have the right to be informed of policies governing compliance with Universal Precautions.  This information is available upon request.
    
14. To request a listing of all individuals or other legal entities who have ownership or control interest in the agency.

CUSTOMER RESPONSIBILITIES

*If applicable to the services you receive:

1. You are responsible for providing complete and accurate information about illnesses, hospitalizations, medications and other matters relating to your health.
   
2. You are responsible for informing the agency when you will not be able to remain at home for services to be provided.
   
3. You are responsible for treating agency personnel with respect.
   
4. You are responsible for cooperating with agency personnel and asking questions if you do not understand any instructions or information given you.
   
5. You are responsible for following your home health care plan.
   
6. You are responsible for participating in the planning of your home health care treatment. You are responsible for providing to the agency any information necessary for processing third party payment of charges for the items and services provided by the agency and/or making arrangements for payment of your bill.
   
7. You are responsible for understanding the following criteria that, when taken singularly or in any combination, indicate an appropriate basis for discharge from VNP services:
   • The customer establishes residence outside the VNP service area.
   • The services needed by the customer exceed the limitations of
     VNP policies.
   • The services needed by the customer exceed the limitations of the availability of VNP staff.
   • The home setting is one in which the services can no longer be rendered effectively in the best interests of the customer and/or the VNP staff.  This includes environmental factors that endanger the safety of customer and/or VNP staff.
   • The customer and/or the customer’s support system are incapable or unwilling to cooperate or participate in the customer’s care.
   • The customer’s home care needs are met or care is refused.
   • Agency financial limitations are such that the customer services can no longer be funded.
   • There is lack of physician certification/orders.
   • Customer’s account is delinquent for services not covered by insurance or third party.  A delinquent account is defined as at least thirty days past due from the invoice date and the responsible person has refused to make payment arrangements.

PATIENT BILL OF RIGHTS

1.  To be fully informed of your rights and responsibilities through effective   means of communication before receiving any home health care service and to exercise these rights.  Your family or legal representative may exercise your rights as permitted by law.  A written notice of the customer’s rights will be provided before initiation of care.

2.  To participate in the planning of your home health care and treatment and to be informed, in advance, of changes in your care including a 5-day discharge notice in accordance with federal and state regulations unless waived by law.  As a participant in your care, you have the right to know what services you are to receive, and how often you are to receive them and the right to make decisions about your medical care including the right to accept or refuse care. 

3.  To form Advance Directives, which direct your care.  The administering of care to you will not be affected by whether you have or don't have advance directives in place.

4.  To maintain confidential clinical records and for the agency to

safeguard your Protected Health Information in accordance

with the Health Insurance Portability Accountability Act unless

waived by law.

 

5.  To access your Protected Health Information.  When

requesting copies of Protected Health Information, a  $0.25 per

page will be assessed plus postage and handling. To request

access to your Protected Health Information: contact the Privacy

Officer, at the phone number listed below.

 

6.  To be informed of the agency’s policies on disclosure of

medical information and how the agency will use and disclose

your Protected Health Information.  Use and disclosure of

Protected Health Information is described in the VNP Notice

of Privacy Practices.  Disclosure of Protected Health Information

not described in the VNP Notice of Privacy Practices shall be

authorized by you or your legal representative unless waived by

law.

 

7.  To have your property treated with respect and dignity, and

to be free from verbal, physical, and psychological abuse.

 

8.  To participate in the consideration of ethical issues arising in

your care.

 

9.  To voice grievances without fear of discrimination or reprisal

about your treatment or care that is (or fails to be) furnished or

regarding the lack of respect for property by anyone who is

furnishing services on behalf of the agency.  You may inform the

agency of such concerns in writing or by telephone by contacting

the Privacy Officer listed below:

 

      Visiting Nurse Plus, Inc.                                 
Privacy Officer
610 E. Walnut St.
P. O. Box 1085
Evansville, IN 47706-1085                                             
Phone: 812-425-0853
Toll Free: 1-800-776-0903

 

10.  To know about the disposition of such complaints. The

agency will investigate complaints made by a customer or

customer’s legal representative regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the customer’s property by anyone furnishing services on behalf of the agency.  The agency will document the existence of the complaint and the resolution of the complaint.

 

11.  To be informed of the availability of the state home health agency hot line to lodge complaints concerning the implementation of the Advance Directives requirements or regarding treatment or care that is (or fails to be) furnished by the home health agency.  IN INDIANA CALL: 1-800-227-6334.  This number is available 24 hours/day, 7 days a week for filing complaints or making inquiries.  Voice mail is available after hours and on holidays and weekends.

 

12.  To be informed of the charges for which you may be liable.  You have the right to receive this information orally and in writing, within thirty working days of the date the agency becomes aware of any changes in charges.  You have the right to have access, upon request, to all bills for service you have received regardless of whether they are paid out-of-pocket or by another party.

 

13.  You have the right to be informed of policies governing compliance with Universal Precautions.  This information is available upon request.

 

14.  To request a listing of all individuals or other legal entities who have ownership or control interest in the agency.

PATIENT RESPONSIBILITIES 

*If applicable to the services you receive:

1.  You are responsible for providing complete and accurate information about illnesses, hospitalizations, medications and other matters relating to your health.

 

2.  You are responsible for informing the agency when you will not be able to remain at home for services to be provided.

 

3.  You are responsible for treating agency personnel with respect.

 

4.  You are responsible for cooperating with agency personnel and asking questions if you do not understand any instructions or information given you.

 

5.  You are responsible for following your home health care plan.

 

6.  You are responsible for participating in the planning of your home health care treatment.

 

7.  You are responsible for providing to the agency any information necessary for processing third party payment of charges for the items and services provided by the agency and/or making arrangements for payment of your bill.

 

8.  You are responsible for understanding the following criteria that, when taken singularly or in any combination, indicate an appropriate basis for discharge from VNP services:

·    The customer establishes residence outside the VNP service area.

·    The services needed by the customer exceed the limitations of VNP policies.

·   The services needed by the customer exceed the limitations of the availability of VNP staff.

·   The home setting is one in which the services can no longer be rendered effectively in the best interests of the customer and/or the VNP staff.  This includes environmental factors that endanger the safety of customer and/or VNP staff.

·    The customer and/or the customer’s support system are incapable or unwilling to cooperate or participate in the customer’s care.

·    The customer’s home care needs are met or care is refused.

·    Agency financial limitations are such that the customer services can no longer be funded.

·    There is lack of physician certification/orders.

·    Customer’s account is delinquent for services not covered by insurance or third party.  A delinquent account is defined as thirty days past due from the invoice date.