Patient Bill of Rights

You have the right to:

1. Be fully informed in advance about care to be provided, including the products/services to be

provided.

2. Participate in the development and periodic revision of the plan of care.

3. Informed consent and refusal of service/care or treatment after the consequences of refusing treatment are fully presented.

4. Be informed of right under state law to formulate an Advanced Directive, if applicable.

5. Be informed, both orally and in writing, in advance of care/service being provided, of the charges, including payment for service/care expected from third parties and any charges for which the customer will be responsible.

6. Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.

7. Be able to identify visiting staff members through proper identification, as applicable.

8. Be free from mistreatment, neglect, or verbal, mental, sexual and physical abuse, including

injuries of unknown source and misappropriation of client/patient property.

9. Voice grievances/complaints regarding treatment or care, lack of respect of property or

recommend changes in policy, staff or service without restraint, interference, coercion, discrimination or reprisal.

10. Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lack of respect of property investigated.

11. Choose a health care provider, including choosing an attending physician.

12. Confidentiality and privacy of all information contained in the customer record and of Protected Health Information.

13. Be advised on company’s policies and procedures regarding the disclosure of clinical records.

14. Receive appropriate service/care without discrimination in accordance with physician orders.

15. Be informed of any financial benefits when referred to an organization.

16. Be fully informed of one’s responsibilities.

17. Receive information about the scope of services that the organization will provide and specific limitations on those services.

Customer Responsibility

It’s Your Responsibility To:

1. Dial 911 whenever a life threatening medical emergency arises.

2. Provide complete and accurate information regarding your history and billing information.

3. Comply with your physician’s orders and treatment plan.

4. Use and care for the medical supplies provided, and not allow use by anyone else.

5. Contact us of any product malfunction or defect, and allow our staff to correct the problem.

6. Advise us of any changes in your status, including address, medical condition, physician, or

billing information.

7. Assume payment responsibility for products/services not covered by your insurance carrier,

except where not allowed by law.

Complaint Procedure

1. If you have any concerns about the products or services provided to you by Arriva Medical, you

may express these concerns by e-mail, telephone, or in writing. Direct your call or letter to our

Customer Service Manager or to our Compliance Officer:

• E-mail: customerservice@arrivamedical.com

• Address: 4252 NW 120th Avenue, Coral Springs, FL 33065

• Telephone: 1-800-700-4442

2. You will receive a response to the extent possible at the time of your complaint when it is

received. If we are not able to respond to you verbally at the time reported, you will receive

a response by telephone within five (5) calendar days. A written response will be sent within

fourteen (14) calendar days.

3. In addition to the complaint procedures listed above, if you do not receive satisfactory resolution from us, you can contact our accrediting organization, ACHC, at 1-919-785-1214; or if you are a Medicare beneficiary, you can contact Medicare at 1-800-633-4227. Our mission is to provide superior customer service to you.