As a customer and patient of Wellstart Medical (“Wellstart” or the “Company”) you have the right to:

1. Be fully informed, in advance, about the service to be provided by Wellstart;

2. Be fully informed of any financial, or other responsibility as soon as it is readily known;

3. Receive information about the scope of services that the Company will provide and specific
   limitations on those services;

4. Refuse service after the consequences, if any, of refusing service are fully presented;

5. Be informed of client/patient rights under state law;

6. Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality;

7. Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of client/patient property;

8. Voice grievances or complaints regarding the Company, service, or lack of respect of property, or recommend changes in policy, personnel, interference, coercion, discrimination, or reprisal;

9. Have grievances or complaints regarding the Company or service that is, or fails to be furnished, or lack of respect of property;

10. Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information kept or maintained by Wellstart;

11. Be advised of the Company’s policies and procedures regarding the disclosure of clinical records;

12. Receive appropriate service and care without discrimination and in accordance with physician’s orders;

13. Choose a health care provider, including an attending physician;

14. Receive appropriate care without discrimination and in accordance with physician orders;

15. Be fully informed of your responsibilities.

As a customer and patient of Wellstart you have the responsibility to:

1. Promptly report to the Company any malfunctions or defects in the supplies;

2. Use the supplies in compliance with the physician’s order and in a safe and proper manner, follow proper storage, and cleaning instructions;

3. Notify Wellstart of any change in health insurance coverage, address, telephone number, physician or prescribed use;

4. Notify Wellstart upon your admission to a hospital, skilled nursing facility, or home health care agency;

5. Accept and fulfill financial responsibility for equipment and/or supplies furnished by Wellstart that is deemed to be noncovered by your third-party insurance company, including co-pays, co-insurance, deductibles, and any other items;

6. Request further information concerning anything you do not understand.