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Travis Medical is a home medical equipment organization dedicated to providing comprehensive home services to referred patients/clients with the utmost care, quality, and professionalism.

Travis Medical accepts only patients whose home medical equipment needs, as identified by the referring source, can be met by the treatment and/or services offered by this organization. We not only provide the most professional home care products available, we genuinely care for the patients we service.

Patient Assessment: A trained staff member meets with and assesses the needs of the patient with respect to the services

and equipment provided. Patients are continually monitored and assessments updated to ensure care that is timely and current.

Delivery Service: Delivery service, setup, patient instruction, and patient training are free of charge.

Patient Instruction and Training: A trained staff of Home Medical Equipment (HME) professionals ensures that each patient is fully trained on the operation and care of equipment through instruction that is carried out in the comfort of the patient’s home.

Reimbursement Assistance: Medicare, Medicaid, and other third party payers are pre-qualified for direct payment.

Discharge Assistance: We work directly with physicians and/or discharge planners to ensure smooth transitions from hospital care to home care.

Business Hours: Monday through Friday: 8:30am to 5:00pm

24-hour Emergency Service: Emergency assistance is available to our patients through a 24-hour phone answering service.

Geographic Scope of Service: Travis Medical’s service area is comprised of these metro and surrounding counties in:

Abilene, Austin, Brownwood, Cleburne, Corpus Christi, Dallas/Fort Worth, El Paso, Houston, San Angelo, San Antonio, Tyler, Oklahoma City

Travis Medical consists of a staff of dedicated and professional specialists who take pride in the exceptional care and service they provide. At Travis Medical, we’re convinced that patients are happier and progress faster when they can convalesce in the comfort and familiar surroundings of their own home. Our objective is to be an active and professional participant in making this a reality.

Equipment and Services Travis Medical offers the following home care equipment services to our patients: Complex Rehab (ATP): Supply Services: Bathroom Safety: Lifestyle Furnishings: Seating & Positioning Enterals Tub Transfer Benches Hospital Beds- Semi, Full, & Manual Power Chairs & Scooters Urologicals Shower Chairs Overbed Tables Manual – Standard & Lightweight Incontinence Raised Toilet Seats Trapeze Bars Adult, Youth & Pediatric Sizes Commodes Seat Lift Chairs Wheelchair Accessories & Supplies Grab Bars Alternating Pressure Pads Patient Lifts Walking Aids Diagnostic Products The above listing covers major products available from Travis Medical but is not a complete listing of inventory or product availability.

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Customer Rights – You have the right to: To be fully informed in advance about the plan of care and to be informed of any modifications to this plan.

To participate in the development and periodic revision of the plan of care.

To refuse services or treatment after the consequences of refusing treatment have been fully presented.

To be informed in advance of any charges for services, including payment for care expected from third parties and any charges the client may be liable for.

To have one’s property and person treated with respect, consideration, and recognition of client dignity and individuality.

To be able to identify visiting staff members through proper organizational identification.

To voice grievances/complaints or recommend changes in policy, staff, or service without restraint, interference, coercion, discrimination, or reprisal.

To choose a health care provider.

The confidentiality and privacy of all information contained in the client/patient record and of all Protected Health Information (PHI).

To be informed of the client right under state law to formulate advanced care directives.

To receive appropriate and professional care (in accordance with physician orders) without discrimination.

To be informed of any financial benefits when being referred to an organization.

To be informed of anticipated outcomes of care and of any barriers in the achievement of this outcome.

To request restrictions on the release of medical information.

To revoke any previous consent or authorization for the release of medical information.

To examine and obtain a copy of your health record and request corrections.

To request copies of any disclosures of your medical record.

To be informed of one’s responsibilities.

To be informed of any provider or service care limitations.

Customer Responsibilities - It is your responsibility to: To properly use and care for the equipment provided and to not allow its use by anyone other than the authorized patient.

To comply with your physician’s order and plan of care.

To provide complete and accurate information regarding your health history and billing information.

To review Travis Medical’s safety materials and actively participate in maintaining a safe environment in your home.

To request additional assistance or information on any phase of your health care plan you do not fully understand.

To notify your attending physician when you feel ill or encounter any unusual physical or mental stress or sensations.

To dial “911” whenever a life threatening medical emergency arises.

To notify Travis Medical when you will not be home at the time of a scheduled home care visit.

To notify the Travis Medical prior to changing your place of residence or your telephone number.

To notify the Travis Medical when encountering any problem with equipment or service.

To assume payment responsibility for services not covered by your insurance carrier, expect where not allowed by law.

To pay for the replacement costs of any equipment damaged, destroyed, or lost due to misuse, abuse, or neglect.

To notify Travis Medical if you are to be hospitalized, enrolled in hospice, skilled nursing facility, home health organization or if your physician modifies or ceases your home care prescription.

To make a conscious effort to properly care for equipment supplied and to comply with all aspects of the home health care plan developed for you.

To notify Travis Medical, of any denials and/or restrictions of the organization’s privacy policy.

Collections & Rental Notice Policy Travis Medical reserves the right to:

To assess the patient a $25.00 fee if the account is turned over to a third party collection service due to non-payment.

To turn a patient account over to a third party collection service for the retail cost of the equipment plus the remaining balance if the rental equipment is not returned.

Please keep in mind that certain insurances require durable medical equipment to be billed as a rental until a pre-allocated time or

payment amount has been satisfied. If you are unsure of this policy, or if you have additional questions regarding rental periods, please contact your insurance provider or Travis Medical customer service for further clarification.

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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 enrollment 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 and must maintain a visible sign with posted hours of operation. The location must be accessible to the public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.

8 A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier's compliance with these standards. 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, answering service or cell phone during posted business hours 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 is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition see 42 CFR 424.57 (c) (11).

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

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 standards to each beneficiary it supplies a Medicare-covered item. 17 A supplier must disclose 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 include 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 DMEPOS 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 A supplier must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). 27 A supplier must obtain oxygen from a state-licensed oxygen provider. 28 A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f) 29 A supplier is prohibited from sharing a practice location with other Medicare providers and suppliers. 30 A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848 (j) (3) of

the Act) or physical and occupational therapists or a DMEPOS supplier working with custom made orthotics and prosthetics.

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Assignment of Benefits I request that payment of authorized Medicare or any other third party payor benefits be made either to me or on my behalf to Travis Medical for any services furnished to me by that supplier. I authorize any holder of medical information about me to release to the Centers for Medicare & Medicaid (CMS) or to any third party payor and its agents in order to determine the benefits or the benefits payable for related services.

Notice of Privacy Practices This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact:

Travis Medical Sales Corporation ● 1104 W. 34th

Street ● Austin, TX 78705 ● (512) 458-4589 ● Attention: Justin Yule or Charles Gola

This Notice of Privacy Practices describes how Travis Medical may use and/or disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you that may identify you and that relates to your past, present, or future physical, medical, and/or mental health or condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time, but we will provide a new notice to you upon treatment following the change.

Your Health Information Rights Although your health record is the physical property of Travis Medical, the information belongs to you. You have the right to:

Request a restriction on certain uses and disclosures of your information.

Inspect and obtain a copy of your health record unless access is restricted by law.

Amend your health record.

Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Obtain an accounting of authorized disclosures.

Any request to amend or copy your protected health information must be made in writing. Requests for restrictions must also be made in writing and will not be accepted if it has a negative impact on the operational delivery of care.

Our Responsibilities This organization is required to:

Maintain the privacy of your health information.

Provide you with a notice as to our legal duties and privacy practices with respect to your protected health information.

Abide by the terms of this notice

Notify you if we are unable to agree to a requested restriction.

Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Officer, Charles Gola, at (512) 275-9847 for more information about the complaint process or to obtain additional information about any other matters in this notice.

Disclosures for Treatment, Payment, and Health Operations 1. We will use your health information for treatment. When you receive treatment, the provider will record information in your file and it will be

used to determine the course of treatment that will work best for your condition. Copies of your record will be provided to the healthcare provider that will include copies of tests and reports in order to permit quality care. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

2. We will use your health information for payment. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

3. We will use your health information for regular health operations. Members of our quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

4. Business Associates: There are some services provided in our organization through contracts with business associates. These may include our billing service, collection agencies, accreditation bodies, consultants, lawyers, and auditors. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.

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5. Law: We may disclose health information as required by law, in response to a valid subpoena, or by law officials during an investigation All other uses and disclosures will be made only with your authorization and you may revoke such authorization at any time by giving us written notice.

Customer Concerns Our goal is to provide nothing but the highest quality of services to our patients. This is why your concerns are our concerns. If you have any concern about the services you are receiving from our organization, we would like to hear from you. You may contact our Customer Service Department at (512) 458-4589. If they are not able to resolve your concern, the concern will be forwarded to the Customer Service Manager who will contact you within 3 business days to resolve your concern/complaint. Also, below are hotline numbers which you may contact regarding fraud, abuse, or treatment concerns provided by our organization.

Medicare Hotline (800) 447-8477 Accreditation Commission for Health Care (919) 785-1214 Texas Medicaid Hotline (800) 252-8263 Texas State Board of Pharmacy (512) 305-8000

Advance Directive/Resuscitation Policy We at Travis Medical have provided you with a Bill of Rights and shall honor those rights. We understand that the formation of Advance Directives and/or living wills is part of your rights as a patient. The staff of Travis Medical will not assist in the formation of advance directives. We advise you to contact your physician, attorney, and/or clergy to assist in the formation of such directives. The employees of Travis Medical will honor those advance directives, which have been directed to us by you or your physician, to the best of our ability. Due to the ethical and moral preferences of the staff, out policy states that we shall not remove life support equipment from a patient. We hope that you understand this policy, and if you have any questions, will call us and discuss this policy with one of our professional staff members. In an emergency situation where medical assistance is required and there is not an advance directive in place, the Respiratory Therapist, who is trained to perform CPR, will call 911 and begin CPR as required. All other employees of Travis Medical would call 911 and wait for emergency medical assistance to arrive.

Texas Medicaid Hotline (800) 252-8263 Texas State Board of Pharmacy (512) 305-8000

Our Locations

TMSC-Abilene 4397 Crawford

Abilene, TX 79602 325-793-3546

TMSC-Central Austin 1104 W. 34th St. Austin, TX 78705

512-421-7100

TMSC-North Austin 3201 Industrial Terrace

Austin, TX 78758 512-458-4589

TMSC-South Austin 611 W. Ben White Blvd

Austin, TX 78704 512-693-0452

TMSC-Brownwood 118A South Park Drive Brownwood, TX 76801

325-693-3290

TMSC-Cleburne 604 N. Nolan River Rd

Cleburne, TX 76033 817-645-4718

TMSC-Corpus Christi 2910 S. Padre Island Dr. Corpus Christi, TX 79415

361-806-2772

TMSC-Dallas/Ft. Worth 1850 Crown Dr, Ste 1114

Farmers Branch, TX 75234 469-904-8850

TMSC-El Paso 11436 Rojas

El Paso, TX 79936 915-629-7174

TMSC-Houston 1332 Upland Drive Houston, TX 77043

713-468-0696

TMSC-Oklahoma City 2704 SW 44th Street

Oklahoma City, OK 73119 405-682-2222

TMSC-San Angelo 1724 Sunset Drive

San Angelo, TX 76904 325-223-6400

TMSC-San Antonio - Alamo Downs 6894 Alamo Downs Pkwy

San Antonio, TX 78238 210-767-8004

TMSC-San Antonio – Gulfdale 10421 Gulfdale St.

San Antonio, TX 78216 210-366-1215

TMSC-Tyler 13213 Hwy 155 South, Ste B

Tyler, TX 75703 903-509-4446