Individuals signing for the customer represent that they are duly authorized to do so and that once signed, this agreement becomes binding upon the patient. The patient agrees to pay for replacement cost of any equipment damaged, destroyed, or lost due to misuse, abuse, or neglect. The customer agrees not to modify the rental equipment without prior written consent of Gammie HomeCare.
The customer agrees that Title to the rental equipment and all parts shall remain with Gammie HomeCare at all times, unless equipment is purchased and paid for in full. Gammie HomeCare fully warrants used equipment purchased for a minimum of 30 days from date of purchase. The patient agrees that if they or their respective insurance company(s) fail to make payment within 30 days after it becomes due, Gammie HomeCare shall have their rights to reacquire all equipment.
Also, to pay interest 1.5% per month on any delinquent balance, and in the event that a delinquent account is placed in the hands of a licensed collector, or attorney, to pay in addition to the amount of said account an equal to 10% thereof to cover collection costs. It is understood that the term for all rentals shall repeat on the monthly anniversary date of the original rental. Lessor shall not be held harm from any damages which might be caused by equipment or any damages which might be caused by failure or breakdown of the equipment.
IF ANY OF THE EQUIPMENT ON THIS ORDER IS BEING PURCHASED,
THE FOLLOWING PARAGRAPH IS APPLICABLE.
It is understood that by entering into this installment sales agreement that Gammie HomeCare retains title to the equipment until all installment and/or service charges are paid in full. Patient’s failure to pay installments in accordance with the terms of this agreement will result in termination of agreement and Gammie HomeCare can reacquire equipment. Patient may voluntarily terminate agreement by returning equipment, however, all installment payments made will be considered rental payments and no refunds or adjustments will be made. Gammie HomeCare will assume responsibility for maintenance of equipment during installment period and reserves the right to repair or replace equipment at its sole discretion. Once the final installment and all service charges are paid in full, Title of the equipment will be passed to the customer and the customer will be responsible for all repair and maintenance charges. (Some manufacturer warranties may exceed those mentioned in this agreement.)
As a customer, immediate family member of a customer, or a power of attorney for a customer of Gammie HomeCare you have some basic rights and responsibilities:
- To be informed of your rights and responsibilities before initiation of care.
- To be treated with dignity, respect, and consideration by qualified staff.
- Exercise your rights as a patient or have your guardian exercise your rights.
- Have your personal property treated with respect, dignity, and privacy.
- To have equipment repaired if it is on rental status with Gammie HomeCare.
- To be informed in advance of the extent to which payment may be expected from a third party payer and what costs you will be responsible for and to be advised no later than 30 days after Gammie HomeCare becomes aware.
- To return SALE items within 30 days of sale if in unopened original manufacturer packaging. 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 (oxygen, underpads, electrodes, etc.) Special order items will require a 50% deposit and are non-refundable.
- Refuse all or part of your care and be informed of the expected consequences of such action.
- Expect strict confidentiality of all information.
- To be informed with a reasonable time of anticipated termination or change of services, which services you will continue to need, and where you may obtain such services.
- Participate in the consideration of ethical issues that arise in your care.
- To make a formal complaint regarding equipment, care, or lack of respect without being subject to discrimination or reprisal and to be informed of the resolution within 14 days. Complaints should be made on normal business days Monday – Friday 8:30 am to 5 p.m. and Saturday 8:30 a.m. to 12:30 p.m.
- Gammie HomeCare is accredited for Home Medical Equipment from the Community Health Accreditation Program (CHAP). To make a complaint or request information about our company from CHAP, the hotline is 1-800-656-9656 and is available between the hours of 8 a.m. and 5 p.m. EST.
- Gammie HomeCare maintains 24-hour availability by telephone. Qualified staff is always available to assist with equipment malfunction. Should a life threatening situation arise, it is suggested the patient or caregiver dial “911” for professional emergency assistance.
- Remain under a physician’s care while receiving services which require the order of a physician.
- Provide accurate and complete information about your health history.
- Notify Gammie HomeCare if the patient moves, receives a change in doctor’s orders, is admitted to a long-term facility, or is hospitalized.
- Sign the required contents and releases for insurance billing.
- Pay for all charges that Gammie HomeCare informs you that you are responsible for. 6) Notify Gammie HomeCare when changes in your condition occur which could effect your equipment needs. (revised oxygen liter flow, large weight change, etc.)
- Request further information concerning anything that you do not understand. If the customer is unsure how to use the equipment safely or properly please ask for more education.
- Accept the consequences when you refuse care or are non-compliant.
- Call a minimum of one working day in advance for all deliveries and pick-ups. The routine delivery week is defined as Monday through Friday.
- Provide a safe environment in which your care can be given.
- Return all rented equipment in the same condition in which it was received, normal wear and tear accepted.
- Allow access to equipment if it needs to be repaired.
- Cooperate with the Gammie HomeCare staff. Treat our staff with dignity, respect, and consideration.
- Notify Gammie HomeCare if you are unable to keep an appointment.
- Notify Gammie HomeCare if you are dissatisfied with our services.