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MISSION STATEMENT

DuBois Medical Supply Company has been serving the DuBois area as one of the most highly respected providers of home oxygen and medical products and services for over 30 years. The Company is a privately held organization with far in excess of 100 years of healthcare industry experience among management and staff. DMS plans to utilize this valuable resource in becoming a regional provider.

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DuBois Medical Supply Company & it's regional locations are committed to improving its products and service offerings by developing its financial and human resources, thus positioning itself to meet future challenges in healthcare.

It is the intent of Company management and staff to constantly strive to provide the highest quality home healthcare equipment, supplies, and services to all its patients, while returning a fair profit to the owners. Patient rights, responsibilities, dignity and confidentiality are always of the highest priority in the delivery and follow-up process and include the right to appropriate pain management and nutritional assessment. The staff is continually updated in the latest in home healthcare and technology through attendance at national seminars, participation in factory training programs, in-house education and other appropriate methods.

The quality of service is constantly monitored by our Performance Improvement Team. Patients always retain the right to clearly voice their dissatisfaction, concern, or content with services rendered without fear of reprisal.

DuBois Medical Supply Company does not discriminate against any person because of race, color, sex, religion, national origin, or age, and complies with all federal, state and local law and regulations.


DUBOIS MEDICAL SUPPLY COMPANY POLICY

REGARDING ADVANCED DIRECTIVES & RESUSCITATION

DuBois Medical Supply Company wishes to inform you of our company's position with respect to resuscitative and life-sustaining action.

Qualified medical personnel serving you are instructed to initiate appropriate resuscitative or life-sustaining methods should such action prove necessary in their presence unless your physician or other legal representative has informed us of the presence of an advance directive requesting the withholding of resuscitative services.

Should such a directive be in effect, or should you choose to formulate such a directive, you must inform the organization, through a staff member, so that appropriate steps can be taken. Should you have questions on advance directives, kindly contact our Director of Clinical Services at (814) 375-1100.

CMS MEDICARE DMEPOS SUPPLIER STANDARDS

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.

2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.

3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.

4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.

5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.

6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.

7. A supplier must maintain a physical facility on an appropriate site.

8. A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier's compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.

9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine or cell phone is prohibited.

10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier's place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.

11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.

12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.

13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.

14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.

15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.

16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.

17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.

18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.

19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.

20. Complaint records must maintain the following: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.

21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.

22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals).

23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.

24. All supplier locations, whether owned or subcontracted, must meet the DMEOPOS quality standards and be separately accredited in order to bill Medicare.

25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.

26. Must meet the surety bond requirements specified in 42 C.F.R. 424.57(c).


Please be advised that any concerns or complaints regarding the quality of care being provided by DuBois Medical Supply Co., Inc. should first be brought to the attention of management at DuBois Medical Supply Co., Inc. If your concern or complaint is not resolved to your satisfaction, you may contact ACHC, (Accreditation Commission for Health Care, Inc.), toll free at 855-937-2242, or visit their website at www.achc.org .Please note, disputes involving billing, insurance, or payments are not within the ACHC authority.

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