Patient Rights and Responsibilities
Normal business hours are 9:00am – 5:00pm M-F an after-hours charge will be applied to all services outside these hours.
It is understood by the parties to this agreement that the word “COMPANY” when used in this agreement, refers to Resort Oxygen.
The “PATIENT” is understood to be the person receiving medical equipment and/or supplies from the Company. Individuals signing for the patient represent that they are duly authorized and that once signed, this agreement becomes binding, jointly and severally, upon the patient and the signor.
The patient agrees to care for, use as instructed, and return the rental equipment in good condition, normal wear and tear excepted, at the end of the rental period. The patient agrees that services will renew automatically, and billing will continue monthly until the equipment is returned to the company. The patient agrees to pay for the replacement cost of any equipment damaged, destroyed, or lost due misuse, abuse, or neglect. The patient agrees not to modify the rental equipment without the prior written consent of the Company. The patient agrees that any authorized MODIFICATIONS shall belong to the title holder of the equipment.
The patient agrees that TITLE to the rental equipment and all parts shall remain with the Company at all times, unless equipment is purchased and paid for in full. The patient agrees not to assign POSSESSORY RIGHTS in the rental equipment or allow the use of the rental equipment by anyone other than the patient.
It shall be the responsibility of the patient to promptly notify the Company of any rental equipment malfunctions or defects, and allow Company equipment service representatives to enter the patient’s premises at all reasonable times to REPAIR, relocate, perform regularly scheduled services, or provide adequate substitute equipment. The Company GUARANTEES all equipment to be delivered operating within manufacturer’s specifications and to be fully warranted to the manufacturer’s current policy. The company fully warrants used equipment purchased for a minimum of thirty (30) days from the date of purchase.
In the event the PATIENT and/or SIGNOR fails to pay for the equipment during the rental period or return equipment and the expiration of the rental period, DEFAULT INTEREST at twenty (20) per cent per annum shall accrue from the date of default. If collection efforts become necessary, the Company shall be asking for treble damages associated with conversion and rights in stolen goods under C.R.S. section 18-4-401 et seq. The patient agrees the Company shall not insure or be responsible to the patient 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.
The patient agrees that if they or their respective insurance company(s) fails to make PAYMENT on any rental purchase within sixty (60) days after it becomes due, the Company shall have the right to pick up all equipment. Sales RETURNS will be accepted in unopened packages and/or sellable condition within thirty (30) days from original invoice with proof of purchase. A minimum of one-month rental may be deducted (where applicable). No merchandise will be accepted for return if worn next to the skin, used for sanitary or hygienic purposes, or if it is disposable (i.e., oxygen, underpads or diapers, lancets, electrodes gels, etc.). Special order items will require a fifty (50) percent deposit and are non-returnable.
The patient shall be responsible for notifying the Company of all changes in their medical status (i.e., revised oxygen liter flow rate, hospitalization change of address, etc.). The patient will notify the representative of Resort Oxygen. of any Advance Directive, and understands the importance of an Advance Directive.
The Company maintains twenty-four (24) hour availability by telephone. Qualified staff is always available to assist with equipment malfunction, or other EMERGENCIES. Should a life-threatening situation arise, it is suggested the patient or caregiver dial “911” for professional emergency assistance.
Patients wishing to express their dissatisfaction, concern, or content with any Company service should contact Company, on business days between 9am and 5pm MST at 970-468-0142. All disputes must be brought to the attention of the company within 30 days of last billing date. Patient may also notify ACHC at 919-785-1214. Your COMMENTS will be fully reviewed and acted upon, as necessary, by the Company. Your comments may be given without fear of reprisal by the Company, or any of its employees.
It is understood that all patient’s personal information shall be kept strictly CONFIDENTIAL by the Company and are not released without written consent, unless authorized by law.
The Company retains the RIGHT TO REFUSE DELIVERY of service to any patient, at any time. This policy is in the interest of health and safety to Company employees. The Company also retains the right to refuse to place equipment in an unsuitable home environment where the equipment cannot be used safely or properly.
All costs of collections, including but not limited to, attorney’s fees, costs of service and filing, and/or other court costs shall be paid by the non-prevailing party. All actions concerning enforcement of dispute of this Agreement shall be venued in Summit County, State of Colorado.
INFORMED CONSENT: The patient retains the right to participate and make decisions about the plan of care and development of the plan of care. The patient retains the right to refuse Company services and/or equipment and assumes full responsibility for any consequence whatsoever relating to REFUSAL of any service ordered delivered to the patient by a healthcare professional. The therapy that was described to you by your doctor is low risk and no results are guaranteed.
NOTICE OF PRIVACY PRACTICES /
Maintaining privacy of your health information is very important to us. Complete Notice of Privacy Practices is available upon request. The following is a summary of the content of the Notice of Privacy Practices. We encourage you to read the entire Notice and ask any questions you may have regarding its content.
How We May Use and Disclose Health Information About You. This section describes the different ways we may use or disclose your health information without first obtaining specific authorization from you. These types of uses and disclosures are specifically permitted by law because it is assumed you would want us to use or disclose your information for these purposes, or because such use or disclosure is recognized as critical to the functioning of our health care system.
Your Rights Regarding Your Health Information. This section describes the following right you have with respect to your health information and tells you how you may exercise these rights.
- Right to inspect and copy
- Right to request amendment
- Right to request an accounting of disclosures
- Right to request restrictions on certain uses and disclosures
- Right to request alternative means of communication
- Right to receive a paper copy of our Notice of Privacy Practices
How to File Complaints Concerning Our Privacy Practices. This section tells you what you can do if you believe any of your rights have been violated. You will not be penalized for filing a complaint.
We ask you to acknowledge your receipt of the Notice by signing below. The most current copy of our Notice of Privacy Practices will be posted in our office. If there are material changes to this Notice later, you will be provided a copy of the revised Notice and asked to sign another acknowledgement.
I acknowledge that I received or was offered a copy of my provider’s Notice of Privacy Practices.
Summit Oxygen Inc.