Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider's or health care facility's right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility. A summary of your rights and responsibilities follows:

• A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
• A patient has the right to a prompt and reasonable response to questions and requests.
• A patient has the right to know who is providing medical services and who is responsible for his or her care.
• A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
• A patient has the right to know what rules and regulations apply to his or her conduct.
• A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
• A patient has the right to refuse any treatment, except as otherwise provided by law.
• A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
• A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
• A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
• A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
• A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
• A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
• A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
• A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
• A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
• A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
• A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
• A patient is responsible for following the treatment plan recommended by the health care provider.
• A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
• A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider's instructions.
• A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
• A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.

History.--s. 1, ch. 91-127; s. 65, ch. 92-289; s. 656, ch. 95-148; s. 21, ch. 98-89; s. 178, ch. 98-166; s. 64, ch. 99-397; s. 7, ch. 2001-53; s. 2, ch. 2001-116.

Patient acknowledgement

• You may reach the staff at any time during normal business hours or after regular business hours by dialing 239-949-4412 for ANY issues including item trouble shooting, repair, or dressing questions.
• With Acute Wound Care, LLC. Confidentiality and privacy practices are implemented in a professional manner and according to law and regulation.
• Your information may be subject to outside review, when required by law, for appropriate billing purposes, or when requested by organizations authorized by you.
• I have been advised I may rent or purchase inexpensive or routinely purchased medical equipment and have a purchase option on capped rental equipment.
• In most cases you have been instructed by your doctor on dressing application, however instructions have been included for you by us and inside the primary dressing manufacturers’ box. Our supplies are simple. Primary dressings, gauze and tape.
• My Doctor or nurse practitioner has trained me and or my care giver on the application of the products received. I have received the written or pictorial instructions on the use of the items in the manufacturers box and or from Acute Wound Care, LLC.
• I and or my caregiver(s) can use all equipment and item(s) provided safely and effectively in the settings of anticipated use.
• COMPLAINTS – Please contact us any time by phone if you have a complaint or grievance by calling ACUTE WOUND CARE AT 239-949-4412 EITHER DURING OR AFTER HOURS. WE ARE HERE TO HELP YOU. We will address your issue and respond in writing within 14 days. This process is reviewed quarterly for enhanced customer satisfaction. All grievances or complaints are logged and the outcome resolution of the grievance noted. If you are still not satisfied and or wish to report a complaint regarding the services you receive to the state, you can call toll free 888-419-3456.To report abuse, neglect, or exploitation of a person, please call toll free 800-962-2873. To report suspected Medicaid fraud, please call toll-free 1-888-419-3456. Medicaid Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under applicable federal or state law as it relates to Medicaid. The office of the Inspector General at the Agency for Health Care Administration accepts complaints regarding suspected fraud and abuse in the Florida Medicaid system by phone at 1-888-419-3456 or on the Agency web site at http://ahca.myflorida.com/Executive/Inspector_General/medicaid.shtml

Special needs and Emergencies.

• To receive supplies in an emergency situation, contact treating physician at least 3 days in advance of a storm, etc, who will coordinate an advance supply of items up to 30 days.
• If you are a special needs patient, contact Acute Wound Care at 239-949-4412, 9-4:30 (good after hours) for information on how we can put you on a list to contact you in case of an emergency.

ALLERGIES – TELL US!!!
Normally your doctor has asked for allergies before prescribing dressings from Acute Wound Care, LLC. However, IF YOU HAVE ANY ALLERGIES IT IS YOUR OBLIGATION TO LET US KNOW AND WE CAN NOTIFY YOUR DOCTOR AND DOCUMENT YOUR FILE IF NOT DONE SO ALREADY. IF YOU DO NOT RESPOND YOUR FILE WILL INDICATE NO ALLERGIES.