STATEMENT OF PATIENT RIGHTS
As a patient of BioCorrect, LLC (also referred to as “Organization”), the following rights
are afforded to you and your caregiver:
1. The right to be informed in advance upon receiving initial services with BioCorrect, LLC
Orally and in writing of your rights and responsibilities.
The services and equipment to be provided by Organization staff, including the
disciplines that will furnish care and the schedule of visits (if applicable).
Changes in the services or equipment to be provided by Organization staff that may
affect your well-being.
Items and services furnished by (or under arrangements with) Organization for which
payment may be made under Medicare.
Charges for non-covered items or services, furnished by (or under arrangements with)
Organization, the amount you may have to pay, and changes in these charges or items
and services for which you may be liable.
Coverage available for items and services under Medicare, Medicaid, and any other
Federal program of which Organization is reasonably aware.
2. The right to be treated with dignity courtesy, and respect, and to have property treated with
3. The right to accept or decline service or equipment at any time; and to be informed of the
health consequences of this action.
4. The right to make decisions concerning such medical care including the right to accept or
refuse medical or surgical treatment and the right to formulate advanced directives (known
in Michigan as A Medical Durable Power of Attorney), and to be assured that the
BioCorrect, LLC will not condition the provision of care or otherwise discriminate against
you based on whether or not you have executed an advance directive.
5. The right to accept or decline participation in research, experimentation, or educational
training without punitive action being taken against you.
6. The right to receive an explanation of forms that you are requested to sign.
7. The right, unless judged incompetent, to participate in planning care and treatment, including
changes in treatment, services, or equipment.
8. The right to confidentiality of the clinical record and communication between you and
Organization personnel regarding your treatment.
9. The right to receive services and equipment regardless or race, religion, color, national
origin, sexual preference, sex, marital status, age, handicap, or diagnosis.
10. The right to be informed of the names, titles, and qualifications of personnel providing your
care and equipment.
11. The right to reasonable coordination and continuity of care from referral source to durable
medical equipment Organization.
12. The right to privacy during interview, examination and treatment and to refuse observation
by those not directly involved in your care.
13. The right to access health records pertaining to you, and the opportunity to question portions
of any record and to have the record corrected if appropriate, and the right of transfer
information to third-parties from such records in the case of continuing care.
14. The right to voice concerns/complaints regarding the treatment, care, or equipment that is (or
fails to be) provided, or regarding the lack of respect for property by anyone who is
providing care or equipment on behalf of Organization, without discrimination or reprisal.
To voice your concerns or complaints, call the supervisor at the BioCorrect, LLC office.
15. The right to receive an investigation by Organization of complaints made by you, your
family, or guardian regarding treatment or care or equipment that is (or fails to be) provided,
or regarding the lack to respect for property by anyone who is providing care or equipment
on behalf of Organization. We will document both the existence and resolution of the
It is your responsibility:
1. To become independent in care and equipment usage to the extent possible using self,
family or other resources.
2. To give Organization staff accurate information so appropriate decisions for services,
equipment, and payment can be made.
3. To engage a physician and remain under medical supervision, and to inform Organization
staff of changes in your use of equipment or services.
4. To participate with Organization staff in designing and implementing your service plan or
selection of equipment.
5. To supply medication, equipment, or supplies that the Organization is unable to provide.
6. To promptly inform Organization staff of changes in your health or reactions to care,
equipment, and services.
7. To promptly ask for additional information regarding any aspect of your conditions, care
or equipment which you do not understand.
8. To promptly inform Organization staff of any aspects of your care and/or equipment
which you do not choose to follow.
9. To assume responsibility for the consequences of your refusal of treatment.
10. To promptly notify BioCorrect, LLC of the existence of an Advance Directive and of
changes in your Advance Directive, and to provide us with a copy of the Advance
Directive prior to its implementation.
11. To provide the insurance and financial information necessary to determine the sources of
payment for your care.
12. To request an adjustment in BioCorrect, LLC charges for which you are responsible and
which are beyond your ability to pay.
13. To notify BioCorrect, LLC office promptly in advance of a delivery or visit you must
14. To respect the rights of the BioCorrect, LLC staff providing service.
We rely upon you to meet your responsibilities so that appropriate care may be provided.
PROTOCOL FOR RESOLVING COMPLAINTS
FOR ALL PATIENTS INCLUDING MEDICARE BENEFICIARIES
The patient has the right to freely voice grievances and recommend changes in care or services
without fear of reprisal or unreasonable interruption of services. Service, equipment, and billing
complaints will be communicated to management and upper management. These complaints will
be documented on the Documentation of Patient Complaints Form and completed forms will
include the patient’s name, address, telephone number, and health insurance claim number, a
summary of the complaint, the date it was received, the name of the person receiving the
complaint, and a summary of actions taken to resolve the complaint.
All complaints will be handled in a professional manner. All logged complaints will be
investigated, acted upon, and responded to in writing or by telephone by a manager within a
reasonable amount of time after the receipt of the complaint. If there is no satisfactory resolution
of the complaint, the next level of management will be notified progressively and up to the
president or owner of the company.
The patient will be informed of this complaint resolution protocol at the time of initial set-up of
Your complaints or problems are important to BioCorrect, LLC We will give full consideration
to a problem or complaint and will make an effort to resolve the issue in an agreeable manner.
We assure you, that you will have the opportunity to voice grievances and recommend changes
in services and/or policies without discrimination, coercion, unreasonable interruption of
services, or reprisal in any manner from the Organization. If you have a complaint, please do the
1. Submit the complaint either verbally by phone: (616) 356-5030 during and after business
hours or in writing to Administrator:
5147 E. Paris Ave. SE, Suite 21
Kentwood, MI 49512
2. Management staff will contact you or your representative within five (5) calendar days, and
will make every effort to resolve the complaint to your satisfaction.
3. If the complaint cannot be resolved to your satisfaction, you may request that the
Administrator submit your complaint to the Organization’s Board of Directors.
4. We will complete our investigation of the complaint and will provide written notification to
you within 14 calendar days.
** THANK YOU FOR SHARING YOUR CONCERNS WITH US! **
NOTICE OF PRIVACY PRACTICES FOR
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
Our Agency is required by law to maintain the privacy of protected health information and to provide you
adequate notice of your rights and our legal duties and privacy practices with respect to the uses and
disclosures of protected health information. (45 CFR 164.520) We will use or disclose protected health
information in a manner that is consistent with this notice.
The agency maintains a record (paper/electronic file) of the information we receive and collect about you
and of the care we provide to you. This record includes physician’s orders, assessments, equipment and
services provided, clinical progress notes and billing information.
As required by law, the agency maintains policies and procedures about our work practices, including
how we provide and coordinate care provided to our patients.
As our patient, information about you must be used and disclosed to other patients for purposes of
treatment, payment and health care operations. Examples of information that must be disclosed:
Treatment: Providing, coordinating or managing health care and related services, consultation
between health care providers relating to a patient or referral of a patient for medical services or
equipment from one provider to another.
Payment: Billing and collecting for services provided, determining plan eligibility and coverage,
utilization review (UR), precertification, medical necessity review.
Health Care Operations: General agency administrative and business functions; quality
assurance/improvement activities; medical review; auditing functions; developing clinical
guidelines; determining the competence or qualifications of health care professionals; evaluating
agency performance; conducting training programs with new employees; survey, certification,
accreditation and credentialing activities; internal auditing; and certain marketing activities.
The following uses and discloses do not require your consent, and include, but are not limited to, a release
of information contained in financial/medical records including information concerning communicable
diseases such as HIV, AIDS, drug/alcohol abuse, psychiatric diagnosis and treatment records and/or
laboratory test results, medical history, treatment progress, or any other related information to:
Your insurance company, self-funded or third-party health plan, Medicare, Medicaid or any
other person or entity that may be responsible for paying or processing for payment any portion
of your bill for services;
Any person or entity affiliated with or representing us for purposes of administration, billing,
and quality and risk management;
Any hospital, nursing home or other health care facility to which you may be admitted;
Any assisted living or personal care facility of which you are a resident;
Any physician providing care;
Licensing and accrediting bodies;
Other health care providers to initiate treatment.
We are permitted to use or disclose information about you without consent or authorization in the
In emergency treatment situations, if we attempt to obtain consent as soon as practicable after
Where substantial barriers to communicating with you exist and we determine that the consent is
clearly inferred from the circumstances;
Where we are required by law to provide treatment and we are unable to obtain consent;
Where the use or disclosure of medical information about you is required by federal, state or local
Certain judicial administrative proceedings;
Certain law enforcement purposes;
To coroners, medical examiners, and funeral directors;
For certain research purposes;
To avert a serious threat to health and safety;
For specialized government functions;
For Worker’s Compensation purposes.
We are permitted to use or disclose information about you without consent or authorization provided you
are informed in advance and given the opportunity to agree to or prohibit or restrict the disclosure in the
Use of directory of individuals served by our Agency
To a family member, relative, friend, or other identified person, the information relevant to such
person’s involvement in your care of payment for care; to notify a family member, relative,
friend, or other identified person of the individual’s location, general condition or death.
Other uses and disclosures will be made only with your written consent. That consent may be revoked, in
writing, at any time, except in limited situations.
You have the right to:
Request restrictions on uses and disclosures of your protected health information.
Confidential communication of protected health information.
Inspect and obtain copies of protected health information.
Request to amend protected health information.
Receive an accounting of disclosures of protected health information.
Obtain a paper copy of this notice.
If you believe that your privacy rights have been violated, you may complain to the Agency or to the
Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you
for filing a compliant. For further information regarding filing a complaint, contact:
5147 E. Paris Ave. SE, Suite 21
Kentwood, MI 49512
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone at (616) 356-5030.
IX. Effective Date
This Notice is effective October 1, 2011