Client Privacy Information
For your review and records. You do not need to return to AbleNet.

AbleNet, Inc. is committed to preserving the privacy of your personal health information. In fact, we arerequired by law to protect the privacy of your medical information and to provide you with this noticedescribing the following how your medical information is used and disclosed for your treatment, to obtain
payment for treatment, administrative purposes and to evaluate the quality of care that you receive.
Uses and Disclosures
We use and disclose elements of your Protected Health Information (PHI) in the following ways:••••••••••••••••

Treatment: including, but not limited to, inclient, outclient or psychiatric care.
To your treating physician(s).
Payment: including, but not limited to, asking you about your health care plan(s), or other sources ofpayment; preparing and sending bills or claims; and collecting unpaid amounts, either ourselves or
through a collection agency or attorney.
Health care operations: including, but not limited to, financial or billing audits; internal quality assurance;
personnel decisions; participation in managed care plans; defense of legal matters; business planning;and outside storage of our records.
Disclosures when release is authorized by law: including, but not limited to, judicial settings and tohealth oversight regulatory agencies, law enforcement and correctional institutions.
Uses or disclosures for specialized government functions: including, but not limited to, the protection of
the President or high-ranking government officials; for lawful national intelligence activities; for military
purposes; or for the evaluation and health of members of the foreign services.
In emergency situations or to avert serious health / safety situations.
If you are a member of the armed forces, we may release medical information about you and yourdependents as requested by military command authorities.
Disclosures of de-identified information.
Disclosures relating to worker’s compensation claims.
To medical examiners, coroners or funeral directors to aid in identifying you or to help them in
performing their duties.
To organizations that handle organ and tissue donations.
To public health organizations or federal organizations in the event of a communicable disease or toreport a defective device or untoward event to a biological product (food or medication).
Disclosures to “business associates” who perform health care operations for us and who commit torespect the privacy of your health information.
We may be required or permitted by certain laws to use and disclose your medical information for otherpurposes without your consent or authorization
We will notify you by e-mail or US Mail of any breaches of your PHI

You have the following rights concerning your protected health information (PHI):
Restrictions
To request restricted access to all or part of your PHI, contact the organization’s HIPAA Privacy and Security
Officer. We are not required to grant your request and you do not have the right to restrict disclosuresrequired by law. If we do agree, we must honor the restrictions you request.

Client Privacy Information: Page 1 of 1

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Updated August 15, 2024 12:53 PM

Rights and Responsibilities
For your review and records. You do not need to return to AbleNet.

As our customer, you are hereby provided this Bill of Rights. You have the right to be notified in writing ofyour rights and obligations before treatment has begun. The patient’s family or guardian may exercise thepatient’s rights when the patient has been judged incompetent. We fulfill our obligation to protect andpromote the rights of our patients, including the following:
Customer Rights
As the patient/caregiver, you have the RIGHT to:
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Be treated with dignity and respect.
Confidentiality of patient records and information pertaining to a patient’s care
Be presented with information at admission in order to participate in and make decisions concerning
your plan of care and treatment.
Be notified in advance of the types of care, frequency of care, and the clinical specialty providing careand be notified in advance of any change in your plan of care and treatment.
Be provided equipment and service in a timely manner.
Receive an itemized explanation of charges.
Express grievance without fear of reprisal or discrimination.
Receive respect for the treatment of one’s property.
Be informed of potential reimbursement for services under Medicare, Medicaid or other third party
insurers based on the patient’s condition and insurance eligibility (to the best of the company’sknowledge).
Be notified of potential financial responsibility for products or services not fully reimbursed by Medicare,
Medicaid or other third party insurers (to the best of the company’s knowledge).
Be notified within 30 working days of any changes in charges for which you may be liable.
Be admitted for service only if the company can provide safe, professional care at the scope and level ofintensity needed; if we are unable to provide services then we will provide alternative resources.
Purchase inexpensive or routinely purchased durable medical equipment.
Expect that we will honor the manufacturer’s warranty for equipment purchased from us.
Receive essential information in a language or method of communication that you understand.
Each patient has a right to have his or her cultural, psychosocial, spiritual, and personal values, beliefs
and preferences respected.
To be free from mental, physical, sexual, and verbal abuse, neglect and exploitation.
Access, request an amendment to, and receive an accounting of disclosures regarding your healthinformation as permitted under applicable law.

Customer Responsibilities
As the patient/caregiver, you are RESPONSIBLE for:
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Notifying the company of change of address, phone number, or insurance status.
Notifying the company when service or equipment is no longer needed.
Notifying the company in a timely manner if extra equipment or services will be needed.
Participating in the plan of care/treatment.
Notifying the company of any change in condition, physician orders, or physician.
Notifying the company of an incident involving equipment.
Meeting the financial obligations of your health care as promptly as possible.
Providing accurate and complete information about present complaints, past illnesses, hospitalizations,medications, and other matters pertinent to your health.
Your actions if you do not follow the plan of care/treatment.

Rights and Responsibilities: Page 1 of 2

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Updated August 15, 2024 12:53 PM

Rights and Responsibilities Continued
For your review and records. You do not need to return to AbleNet.

Our Rights
As your provider of choice we have the right to:••

Terminate services to anyone who knowingly furnishes incorrect information to our company to securedurable medical equipment.
To refuse services to anyone who during direct care is threatening, intoxicated by alcohol, drugs and/or
chemical substances and could potentially endanger our staff and patients.

Rights and Responsibilities: Page 2 of 2

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www.quicktalkerfreestyle.com

Updated August 15, 2024 12:53 PM

Supplier StandardsFor your review and records. You do not need to return to AbleNet.

AbleNet, Inc. is committed to preserving the privacy of your personal health information. In fact, we are
required by law to protect the privacy of your medical information and to provide you with this noticedescribing the following how your medical information is used and disclosed for your treatment, to obtain
payment for treatment, administrative purposes and to evaluate the quality of care that you receive.
Uses and Disclosures
We use and disclose elements of your Protected Health Information (PHI) in the following ways:••••••••••••••••

Treatment: including, but not limited to, inclient, outclient or psychiatric care.
To your treating physician(s).
Payment: including, but not limited to, asking you about your health care plan(s), or other sources ofpayment; preparing and sending bills or claims; and collecting unpaid amounts, either ourselves orthrough a collection agency or attorney.
Health care operations: including, but not limited to, financial or billing audits; internal quality assurance;
personnel decisions; participation in managed care plans; defense of legal matters; business planning;and outside storage of our records.
Disclosures when release is authorized by law: including, but not limited to, judicial settings and tohealth oversight regulatory agencies, law enforcement and correctional institutions.
Uses or disclosures for specialized government functions: including, but not limited to, the protection of
the President or high-ranking government officials; for lawful national intelligence activities; for military
purposes; or for the evaluation and health of members of the foreign services.
In emergency situations or to avert serious health / safety situations.
If you are a member of the armed forces, we may release medical information about you and yourdependents as requested by military command authorities.
Disclosures of de-identified information.
Disclosures relating to worker’s compensation claims.
To medical examiners, coroners or funeral directors to aid in identifying you or to help them in
performing their duties.
To organizations that handle organ and tissue donations.
To public health organizations or federal organizations in the event of a communicable disease or toreport a defective device or untoward event to a biological product (food or medication).
Disclosures to “business associates” who perform health care operations for us and who commit torespect the privacy of your health information.
We may be required or permitted by certain laws to use and disclose your medical information for otherpurposes without your consent or authorization
We will notify you by e-mail or US Mail of any breaches of your PHI

You have the following rights concerning your protected health information (PHI):
Restrictions
To request restricted access to all or part of your PHI, contact the organization’s HIPAA Privacy and Security
Officer. We are not required to grant your request and you do not have the right to restrict disclosuresrequired by law. If we do agree, we must honor the restrictions you request.
Federal Supplier Standards
The products and/or services provided to you by AbleNet, Inc are subject to the supplier standards containedin the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards
concern business professional and operational matters (e.g. honoring warranties and hours of operation). The
full text of these standards can be obtained athttps://www.ecfr.gov/current/title-42/part-424/section-424.57#p-424.57(c). Upon request we will furnish youa written copy of the standards.
Supplier Standards: Page 1 of 1

AbleNet Funding Teamfundingservices@ablenetinc.com(651) 294-2211
www.quicktalkerfreestyle.com

Updated August 15, 2024 12:53 PM

About Your QuickTalker Freestyle Warranty andReturn Policy
For your review and records. You do not need to return to AbleNet.

QuickTalker Freestyle
AbleNet provides a variety of ways to learn more about your device. Included with your product is a
Quickstart Guide / Manual. You will find resources at https://www.quicktalkerfreestyle.com and https://quicktalkerfreestyle.zendesk.com/hc/en-us. The websites include a downloadable version of the productmanual and other product information.
Customer Service and our ableCARE product support department are available to answer questions in avariety ways.
•••

You can call (800) 322-0956, Monday through Friday from 8:00am – 5:00pm CST. Closed on Saturday andSunday.
Customer Service E-mail: customerservice@ablenetinc.com
ableCARE Product Support E-mail: ablecare@ablenetinc.com

WarrantyAbleNet provides a 5-year warranty on all QuickTalker Freestyle devices, speech apps included on the device,
and accessories included with the device. During the 5-year warranty period, you will not be charged any
additional fees for speech app subscriptions, in-app purchases related to your speech app, repairs, swapping
one speech app for another speech app, or changing your device size.
Returns
AbleNet offers a 30-day money back guarantee if our products do not meet your needs or expectations.
Products must be in new and unused condition to honor this service; if not, restocking fees may apply.
Please contact AbleNet Customer Service at (800) 322-0956 for inquiries about a return or a return
authorization number.

About Your QuickTalker Freestyle Warranty and Return Policy: Page 1 of 1

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Updated August 15, 2024 12:53 PM

Client Complaint Procedure Information
For your review and records. You do not need to return to AbleNet.

Complaint Procedures
AbleNet, Inc. provides a process for client’s to lodge an oral, written, or telephone complaint about theproducts and services provided. AbleNet, Inc. has a complaint resolution system for identifying, responding
to, and resolving complaints in a timely manner. A client complaint form is available.
A summary of the complaint must include:• Date received• Name of the person receiving the complaint• A summary of actions taken to resolve the complaint• If an investigation is not conducted, the name of the person who made that decision, along with thereason for not conducting an investigation• Signature of supervisor
All employees are trained in how to handle complaints. Copies of all complaints and investigations are kept
on-file for at least three years. All complaints are summarized and presented to Executive Managementquarterly.
If you have a complaint, please contact us at (800) 322-0956. Additionally, you may contact the Centers for
Medicare and Medicaid Services (CMS) at (800) MEDICARE, if needed.
You may also contact our accreditation provider if needed. Our accreditation provider is Health Care Quality
Association on Accreditation and can be reached at (866) 909-4722.
Emergency Preparedness
AbleNet, Inc. has a comprehensive emergency preparedness plan in case a disaster occurs. Our goal is tocontinue to service your health care needs. It is your responsibility to contact us regarding any supplies you
may require when there is a threat of disaster or inclement weather.

Client Complaint Procedure Information: Page 1 of 1

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www.quicktalkerfreestyle.com

Updated August 15, 2024 12:53 PM

Device Management NoticeFor your review and records. You do not need to return to AbleNet.

Medical insurers require the QuickTalker Freestyle speech-generating device to be in a locked state that
only allows the patient to use it for communication purposes when they receive it. AbleNet uses device
management software on your QuickTalker Freestyle to meet the insurer’s requirements.
After you receive your QuickTalker Freestyle, if you connect it to the internet, AbleNet’s device management
software provides AbleNet with limited access to your device. AbleNet will use remote access to your device
to provide support and software updates.
AbleNet’s device management software does not allow AbleNet to see private information stored on yourdevice. Private information includes data stored within an application and files stored on the device.
For questions regarding AbleNet’s device management software, contact ableCARE at (800) 322-0956 or
ablecare@ablenetinc.com.

Device Management Notice: Page 1 of 1

AbleNet Funding Teamfundingservices@ablenetinc.com(651) 294-2211
www.quicktalkerfreestyle.com

Updated August 15, 2024 12:53 PM