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This document serves as an acknowledgement by the patient regarding their responsibility for the use and maintenance of a non-UVA device during ongoing medical treatment at UVa. It outlines the patient's
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How to fill out patient acknowledgement of responsibility
How to fill out Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)
01
Begin by downloading the Patient Acknowledgement of Responsibility for Use of Non-UVA Devices form from the appropriate medical facility's website.
02
Fill in your personal information in the designated sections, including your full name, date of birth, and contact information.
03
Read through the entire document carefully to understand the implications of using non-UVA devices.
04
Provide any required information about the non-UVA devices you intend to use, including their types and purposes.
05
Acknowledge your understanding of the responsibilities outlined in the waiver by signing and dating the form.
06
Review the completed document for accuracy before submission.
07
Submit the completed form to the designated medical provider as instructed, either in person or via any specified electronic method.
Who needs Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
01
Patients who are planning to use medical devices that are not sanctioned or provided by the University of Virginia (UVA) health system.
02
Individuals undergoing treatment at UVA who wish to utilize alternative non-UVA medical devices.
03
Patients who have been advised by their healthcare provider to consider non-UVA devices for their treatment or management.
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What are the patient rights at UVA?
You have the right to: Know about your illness, why you need a treatment, what will happen if you do not have it and possible risks and benefits, so you can take part in making care decisions. Give or refuse consent before procedures or treatments. Agree to or refuse to participate in any research study or experiment.
How do I get my medical records from the UVA hospital?
Get your medical records one of these 3 simple ways: MyChart: online access to your health records, imaging, and more. Use the online health records request tool. Questions about using the tool? Watch this video for answers. Download a form, print it out, and send it to us: Request form: English or Spanish.
What is on the 5th floor of the UVA hospital?
UVA Division of Nephrology and the Center for Immunity, Inflammation & Regenerative Medicine administrative offices are located on the 5th floor of UVA Medical Center's West Complex.
What is the UVA health Compliance Code of Conduct?
Act responsibly. Obey all applicable legal and regulatory requirements as well as UVAH policies and procedures. Participate in training. Respect the rights of UVAH patients, families, and team members.
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What is Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
The Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver) is a document that confirms a patient understands and accepts the risks associated with using medical devices that are not authorized by the University of Virginia (UVA) for their treatment or care.
Who is required to file Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
Patients who choose to use non-UVA devices during their treatment are required to file the Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver).
How to fill out Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
To fill out the Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver), a patient must provide their personal information, acknowledge understanding of the risks involved with the non-UVA devices, and sign and date the document.
What is the purpose of Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
The purpose of the Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver) is to protect the healthcare provider from liability by ensuring that patients are aware of and accept the risks associated with using devices that are not endorsed by UVA.
What information must be reported on Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver)?
The information that must be reported on the Patient Acknowledgement of Responsibility for Use of Non-UVA Devices (Waiver) includes the patient's name, the type of non-UVA device being used, acknowledgment of the associated risks, and the patient's signature and date.
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