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PERSONNEL HONOR THE PATIENT RIGHT TO : ∙ Assure clients to exercise his or her rights as a patient of the HHA ∙ Have his or her property and person treated with respect ∙ Assure by wearing an ID badge, that patient will be able to identify visiting staff through agency generated photo identification ∙ Assure clients the choose a health care provider, including an attending physician ∙ Provide appropriate care without discrimination in accordance with physician orders ∙ Inform clients of any financial benefits when referred to our Agency ∙ Assure clients to be fully informed of one's responsibilities PATIENT RESPONSIBILITIES: Education about your responsibilities a s a Patient, you have the  following responsibilit ies : ∙ Be under a physician's care (licensed in the state of Practice) while receiving t he Home Health Agency Services. ∙ Inform  the Home Health Agency w ith a complete and accurate health history in order to plan and carry out care. ∙ Inform Agency staff about any changes in your health status, condition or treatment. ∙ Provide the Home Health Agency w ith all requested insurance and financial information/records. ∙ Sign or have your legal representative sign the required consents and releases for insurance billing. ∙ Allow the Home Health Agency to act on your behalf in filing appeals of denied payment of service by third‐party payers and to cooperate to the fullest extent possible in such appeals. ∙ Notify the Home Health Agency of any changes in treatment made by the physician. ∙ Participate in your plan of care including, if appropriate, a pain management plan. ∙ Ask your nurse/therapist what to expect regarding pain and painmanagement. Discuss pain relief options with your nurse/therapist. Provide your nurse/therapist with as comprehensive information as possible about your pain  and any concerns you may have about pain medications and/or management. ∙ Be available to The Home Health Agency Staff for home visits at reasonable times. ∙ Notify the Home Health Agency If you are going to be unavailable for a visit. ∙ Treat the Home Health Agency Personnel with respect and dignity without discrimination as to color, religion, sex or national or ethnic origin. ∙ Accept the consequences for any refusal of treatment or choice of noncompliance. ∙ Provide the Home Health Agency Personnel with a safe home environment in which your care can be provided. ∙ Cooperate with your physician, The Home Health Agency Staff and other caregivers. ∙ Inform the Agency if you are unable to understand or follow the Agency’s written instructions. ∙ Make a family member or substitute available who will assume a primary caregiver role when Agency staff are  not in your home. ∙ Notify the Home Health Agency Of the existence of Advance Directives. ∙ Advice the Home Health Agency Of any problem or dissatisfaction you may have with the care or services you are receiving and giving the agency the opportunity to resolve these issues.  page 19 “Confined to the home” (Homebound) if the following two criteria are met: First Criteria: One of the Following must be met: 1. Because of illness or injury, the individual needs the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person to leave their place of residence. 2. Have a condition such that leaving his or her home is medically contraindicated. Second Criteria: Both of the following must be met: 1. There must exist a normal inability to leave home. 2. Leaving home must require a considerable and taxing effort. The patient may be considered homebound (that is, confined to the home) if absences from the home are: Infrequent; For periods of relatively short duration; For the need to receive health care treatment; For religious services; To attend adult daycare programs; or For other unique or infrequent events (for example, funeral, graduation, trip to the barber). Eligibility criteria may vary for different care/service programs. Eligibility criteria is periodically reviewed for appropriateness and continued accessibility to the Agency’s programs. Target populations may be defined generally as anyone needing the care/ service or in some cases may be defined by special funding sources. Other population may be defined by ages (e.g., elderly, infants, children, etc.), special care/service needs (e.g., medical care, homemaking, personal care, etc.), or specific diseases/ disabilities (e.g., Alzheimer..s, Autism, schizophrenia, arthritis, etc.). HOMEBOUND STATUS: sample