Patient's Bill of Rights

At Fusion Footwear, we are committed to providing high-quality care and ensuring that every Medicare patient fully understands their rights and responsibilities.
A printed copy of this document is included in your Welcome Packet, but for your convenience, we’ve also provided the information here online.
Below is a summary of your rights as a Medicare beneficiary receiving services at Fusion Footwear. These rights are designed to protect you, promote respect and dignity, and ensure that you receive the best possible care and service.

Patient's Bill of Rights

As an individual receiving services, let it be known and understood that you have the following rights:

1. To receive the appropriate or prescribed service professionally without discrimination relative to your age, race, sex, religion, ethnic origin, sexual preference, or physical/mental handicap.

2. To be dealt with and treated with friendliness, courtesy, and respect by every individual
representing the company who provides treatment or services for you and be free from neglect or abuse, be it physical or mental.

3. To assist in the development and planning of your care program so that it is designed to satisfy, as best as possible your current needs.

4. To be provided with adequate information from which you can give your informed consent for the commencement of service, the continuation of service or the termination of service.

5. To express concerns or grievances or recommend modifications to your service without fear of discrimination or reprisal. Please contact us at 817-840-6769. You can also contact
our accreditation organization, HQAA at 866-909-4722. The Medicare hotline number is 1-800-213-5452.

6. To request and receive complete and up-to-date information relative to your condition,
treatment, alternative treatments, and risks of treatment.

7. To receive treatment and services professionally, while being fully informed as to company policies, procedures, and charges.

8. To refuse treatment and services within the boundaries set by law, and to receive professional information relative to the ramifications or consequences that will or may result due to such refusal.

9. To request and receive the opportunity to examine or review your medical records.

BENEFICIARY AGREEMENT

I agree that I am personally and solely responsible for the payment of charges related to the above described transactions.

Further, I acknowledge that it is my responsibility to obtain or provide necessary forms and documentation, including physician's prescriptions, as may be required to support and document all third-party claims.