JEFFERSON SPECIALT Y PHARMACY

HOME OF SIDNEY KIMMEL MEDICAL COLLEGE

Welcome to Jefferson Specialty Pharmacy

Walnut Home Therapeutics, Inc.

Welcome to Jefferson Specialty Pharmacy. We are very pleased to provide you with the services

needed for your specialty medication therapy.

Specialty medications are used to treat chronic, complex and rare conditions, such as cancer,

hepatitis C, and rheumatoid arthritis, to name a few.

Specialty medications are different because they typically:

• cost more than regular medications

• need to be taken on a very strict and sometimes difficult to follow schedule

• have special storage and handling directions

• are given by mouth (pills), but can be given by injection (with a needle)

• require additional support and coordination amongst a large team of providers We realize there are often additional hurdles to overcome as you navigate through the process

of managing a chronic, complex disease, and there may be limitations such as:

• your ability to follow difficult directions

• your ability to stay compliant with the therapy

• your ability to pay for high cost medications By choosing Jefferson Specialty Pharmacy you will receive a level of care that will lead to increased

health benefits.

As specialists in the medications that treat your disease we will:

• help you to manage side effects better

• help to increase compliance with refill reminder calls

• help overall improvement of your disease ensuring the maximum therapeutic benefits

• help to coordinate your plan of care with all of the members of your healthcare team

• help to find financial assistance which may be available for your situation Enclosed is your patient welcome packet containing information about our operations and services,

patient safety, and other important items. Please read through this information at your leisure, and keep

this packet in a safe place for future reference.

Walnut Home Therapeutics, Inc. (WHT) is our corporate name. We do business as Jefferson Specialty

Pharmacy (JSP). We also have a division known as Jefferson Home Infusion Services (JHIS).

Please recognize that all of these names refer to the same organization.

If you have any questions, please call us at 844-469-7542 or visit us online at hospitals.jefferson.edu/

departments-and-services/specialty-pharmacy

About Jefferson Specialty Pharmacy

The goal of Jefferson Specialty Pharmacy is to provide customized care and improved access to specialty

medications resulting in healthier outcomes. At Jefferson Specialty Pharmacy, our pharmacists and drug

acquisition representatives will work with your prescriber to develop an individualized treatment plan.

You will be involved in your own health care and will be fully integrated in the decision making process.

Jefferson Specialty Pharmacy guarantees that each step in the specialty process will be communicated

and explained to all parties.

At Jefferson Specialty Pharmacy, we are aware that the use of specialty medications can be multifaceted

and require more monitoring than the use of typical pharmaceuticals. In order to assure that you have

the best experience possible we have developed a “Patient Management Program.” This program

has been developed to provide our staff an effective way to appropriately monitor and manage your

medications. Our tools and infrastructure allow us to relay information about your medications,

treatment plans and outcomes to all parties involved. Our interactions will be communicated to the

provider, the payor, and other members of your healthcare team, as needed to achieve the best possible

outcome. This program enables us to provide unparalleled, personalized care.

You will be automatically enrolled in this program and can opt out by informing any member of our staff

Your choice to opt of our program will be documented in our patient management system.

OUR SPECIALTY TEAM:

Pharmacists:

Pharmacists work with you and your provider to perform an initial assessment of your needs and

to create a treatment plan to keep your therapy on target. They will act as liaison between your insurance

and your provider by obtaining any prior authorizations that are required by your insurance. They will

obtain a complete medical history, review allergies, and do medication reconciliation (including over-

the-counter medication). They will provide counseling on medication administration and usage when

filling your prescription. They will distribute manufacturer information regarding your medication,

diagnosis and common treatment options.

Our pharmacists are specially trained on the medication you are taking, and they are here to answer your

questions about your plan of care. Please call Jefferson Specialty Pharmacy if you have any questions

regarding your treatment. A licensed pharmacist is available 24 hours a day, 7 days a week, for any urgent

needs relating to your medication. In the case of an emergency, call 911.

On an ongoing basis, they monitor the safety and effectiveness of your treatment. Pharmacists also

supervise and check the preparation of your medication.

Drug Acquisition Representatives:

Drug Acquisition Representatives (DAR’s) manage refill scheduling throughout the course of therapy.

Each month, you will receive a call before your next refill is due. This is to ensure that there are no lapses

in therapy. DAR’s also research financial assistance for high copays for both Medicare and commercially

insured patients. Financial assistance applications are completed and submitted on your behalf and

tracked until approved. DAR’s also fill your medications under pharmacist supervision.

Delivery Technicians:

Delivery technicians deliver the prescribed specialty medication to your home, workplace, or other

mutually agreed upon destination. Additional on-campus personnel will be able to bring any medication

to on-campus locations when requested.

Billing Specialist:

Our billing representatives work with insurers on your behalf to receive payment for services. They are

also a resource for payment plans, if needed. The contact number for any billing related inquiries is

1-484-580-1664, M-F 8 a.m. to 4:30 p.m. All other questions and concerns aside from billing should go

to 1-844-469-7542.

PHARMACY INFORMATION Our contact information is: Hours of Operation:

Phone: 1-844-469-7542 Monday through Friday, 8 a.m. to 5 p.m. (Eastern Time)

Fax: 215-955-8182 107 S. 10th Street, Rear Entrance, Philadelphia, PA 19107

Email: Specialty.Pharmacy@jefferson.edu A licensed pharmacist is available:

24 hours a day, 7 days a week, for emergency pharmacy services After normal business hours, leave your contact information with our after-hours answering service,

and the pharmacist on-call will promptly return your call.

HOLIDAYS:

Jefferson Specialty Pharmacy is closed on the following holidays:

New Year’s Day (January 1)

Martin Luther King Jr. Day (the third Monday of January)

Memorial Day (the last Monday in May)

Independence Day (July 4)

Labor Day (the first Monday in September)

Thanksgiving (the fourth Thursday in November)

Christmas (December 25)

PHARMACY EMERGENCY DISASTER INFORMATION: If there is a disaster in your area, and you are forced to temporarily relocate, please call 844-469-7542

to instruct us where to deliver your medication. This will ensure that your therapy is not interrupted.

Be sure to also let us know when you have returned to your residence.

Obtaining Medications and Services

HOW TO GAIN ACCESS TO SPECIALTY MEDICATIONS:

Your physician can send us an order:

• Through an electronic ordering system (send to: Walnut Home Therapeutics, Inc., or Jefferson

Specialty Pharmacy) • By faxing a prescription to our fax number 215-955-8182.

Jefferson Specialty Pharmacy will work with your prescriber when you need a new prescription for a refill

of your medication. In many cases, your prescriber will send Jefferson Specialty Pharmacy a new copy

of your prescription. However, you may also call Jefferson Specialty Pharmacy and request that we

contact your prescriber to obtain a new specialty prescription.

Ordering refills:

Before your medication is scheduled to run out, a drug acquisition representative will call you to check

your progress, discuss any changes in your treatment and medications and determine the shipment date

and method of your next refill. You may also call 844-469-7542 and enter your Rx number or talk to

someone directly.

Medications not available at Jefferson Specialty Pharmacy:

If Jefferson Specialty Pharmacy cannot fill your medication for any reason, our staff will work with you

and an appropriate vendor to ensure that you will be able to receive your medication as requested by

your provider.

If you would like your prescription transferred to another pharmacy, please contact our office and

we will transfer your prescription on your behalf.

LOGISTICS SURROUNDING DELIVERY OF YOUR SPECIALTY MEDICATION:

If your medications require special handling or refrigeration, they will be packaged and

shipped accordingly.

If you cannot be there to accept the package, we can arrange for it to be left at an approved

alternate location upon your request.

Delivery:

We will coordinate delivery of your specialty medications to your home, work, prescriber’s

office or an approved alternate location.

Pick up:

Our office hours are Monday through Friday, 8 a.m. to 5:00 p.m. (Eastern Time) White Glove:

If you have an on-campus physician appointment we can bring your medication to your

appointment upon request.

FedEx:

Upon request we can ship medications to appropriate areas within our scope of business.

We require signature upon receipt as these medications are typically very expensive.

INDIVIDUALIZED MEDICATION MANAGEMENT Patient Management Program:

Everyone who receives a specialty medication will automatically be enrolled in our Patient Management

Program as defined on page three. We will call you to discuss your care management plan as developed with your provider upon the initial

delivery of your medication. We will follow up with you monthly to discuss the treatment plan. We will

coordinate care with your provider and alter your treatment plan based on our ongoing assessments.

We will provide coordination of care with third party payer programs and multi-disciplinary teams, as

appropriate, and will communicate with you about any changes or needs that may affect your treatment.

Payment for Services

Jefferson Specialty Pharmacy/Walnut Home Therapeutics, Inc., Inc accepts many types of health

insurance for payment.

When managed care or private insurance, including HMOs and PPO’s, are billed for services, your

benefits are based on a contract between you and your insurance company. You will be responsible for

any charges not paid by your insurance company, including but not limited to deductibles, co-insurance

(co-pay) amounts, or services provided by out of network providers. These amounts will be billed

according to your individual insurance plan.

Government health plans (with the exception of Medicare) usually reimburse for specialty medication

therapy, although in a few states the extent of coverage may have gaps.

Medicare Part B has some coverage for certain therapies. Unfortunately, only a select few select

therapies are covered and only under very specific conditions.

Medicare’s prescription drug plan (Part D) may cover the cost of the medications. You must notify us if there are changes in your coverage. Pre-authorization of services is required

by most managed care and private insurance plans. Our team will work with your provider to ensure

that appropriate prior authorizations requirements are met. Payment may be denied by the insurance

company for all services provided if authorization is not obtained.

Managing Your Medications

Medicines are powerful chemicals used to treat disease, heal injuries, and relieve pain. Used properly,

they can treat everything from headaches to heart disease. If used carelessly, medicines can cause

unexpected danger. Instead of relieving symptoms, they can cause poisoning and, in some cases, death.

The medicines you should know about include herbal preparations, over-the-counter drugs, (those

you can buy without a prescription) and prescription drugs (chosen by your physician and sold by a

pharmacist). Before you use any medicine, your doctor, nurse, or pharmacist should be told if you

ever had an allergic or unusual reaction to any medicine or food.

Be sure you understand

• The medication’s name.

• Why you are taking it.

• How much medication you should take and how to take the medication.

• Side effects and the symptoms of side effects you should report to your doctor.

• Activities you should avoid while taking certain medications. Follow Instructions

• Do not take anyone else’s medications.

• Do not take over-the-counter medications unless they are approved by your doctor.

• Do follow any special safety precautions. Hints

• Always ask your doctor, pharmacist, or nurse about any questions you have.

• Ask for an easy open container if you find that childproof containers are too hard to open.

• Do not discard any expired medications by flushing them down the toilet. See additional information

on following pages under “Proper Disposal of Prescription Drugs.”

• Turn on a light when taking any drug at night so you can read the label.

• Store medications away from heat, moisture and direct sunlight. Keep out of the reach of children.

• Avoid storing your medication in the bathroom medicine cabinet.

• When traveling, carry your medications on your person; do not put them in your luggage.

Carry your doctor’s name and phone number with you. Develop a System

It might be helpful to have a method for keeping tabs on your medicines. If necessary, have someone

help you. Here are a few ways to make a chart:

• Basic Medicine Chart — On a large sheet of paper, write down what medicines to take and

what times to take them. Also note how the medicine should be taken.

• Color-Coded Chart — For your ease, you can color code your medication containers,

using colored markers, pens, pencils, etc.

• Check-Off Chart — List your medicines for each day of the week. Write down what times

each day to take them. Cross out the time when you’ve taken the medicine.

If you need more information about medications and how to take them, please discuss your concerns

with your pharmacist or ordering provider.

Proper Disposal of Prescription Drugs GUIDELINES

• Take unused, unneeded, or expired prescription drugs and prepare them to be properly discarded. • Mixing prescription drugs with an undesirable substance, such as used coffee grounds, kitty litter, or

dish detergent and putting them in impermeable, non-descript containers, such as empty cans or

sealable bags, will further ensure the drugs are not diverted. Discard in trash, not in recycling.

• Flush prescription drugs down the toilet only if the label or accompanying patient information

specifically instructs doing so (see box).

• Take advantage of community pharmaceutical take-back programs that allow the public to bring

unused drugs to a central location for proper disposal. Where these exist, they are a good way to

dispose of unused pharmaceuticals.

The FDA continually evaluates medicines for safety risks and will update the list as needed. Please visit the Disposal of Unused Medicines/What You Should Know page at www.fda.gov for more information.

Medicines recommended for disposal by flushing:

Medicine Active Ingredient

Abstral tablets (sublingual) Fentanyl

Actiq oral transmucosal lozenge * Fentanyl Citrate

Arymo ER, tablets (extended release) Morphine Sulfate

Avinza capsules (extended release) Morphine Sulfate

Belbuca soluble film (buccal) Buprenorphine Hydrochloride

Buprenorphine Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride

Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride; Naloxone Hydrochloride

Butrans transdermal patch system Buprenorphine

Daytrana transdermal patch system Methylphenidate

Demerol, tablets * Meperidine Hydrochloride

Demerol, oral solution * Meperidine Hydrochloride

Diastat/Diastat AcuDial, rectal gel [for disposal instructions:

click on link, then go to “Label information” and view current label

Diazepam

Dilaudid, tablets * Hydromorphone Hydrochloride

Dilaudid, oral liquid * Hydromorphone Hydrochloride

Dolophine Hydrochloride tablets * Methadone Hydrochloride

Duragesic patch (extended release) * Fentanyl

Embeda capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride

Exalgo tablets (extended release) Hydromorphone Hydrochloride

Fentora tablets (buccal) Fentanyl Citrate

Hysingla ER tablets (extended release) Hydrocodone Bitartrate

Kadian capsules (extended release) Morphine Sulfate

Methadone Hydrochloride, oral solution * Methadone Hydrochloride

Methadose, tablets * Methadone Hydrochloride

Morphabond (extended release) Morphine Sulfate

Morphine Sulfate, tablets (immediate release) * Morphine Sulfate

Morphine Sulfate oral solution * Morphine Sulfate

Medicines recommended for disposal by flushing:

Medicine Active Ingredient

MS Contin tablets (extended release) * Morphine Sulfate

Nucynta ER (extended release) Tapentadol

Onsolis (PDF – 297KB), soluble film (buccal) Fentanyl Citrate

Opana, tablets (immediate release) Oxymorphone Hydrochloride

Opana ER (extended release) Oxymorphone Hydrochloride

Oxecta, tablets (immediate release) Oxycodone Hydrochloride

Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride

Oxycodone Hydrochloride oral solution Oxycodone Hydrochloride

Oxycontin tablets (extended release) Oxycodone Hydrochloride

Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride

Percodan, tablets * Aspirin; Oxycodone Hydrochloride

Suboxone film (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride

Targiniq ER (extended release) Oxycodone Hydrochloride; Naloxone Hydrochloride

Vantrela ER, tablets (extended release) Hydrocodone Bitartrate

Xartemis XR tablets Oxycodone Hydrochloride; Acetaminophen

Xtampza ER capsules (extended release) Oxycodone

Xyrem oral solution Sodium Oxybate

Zohydro ER capsules (extended release) Hydrocodone Bitartrate

Zubsolv tablets (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride

Drug Recalls WHY ARE DRUGS RECALLED?

A number of factors can cause a drug to be recalled. A recall may be issued if a medicine is: A health hazard. Unfortunately, some health risks associated with certain medications are not realized

until after they become widely used.

Mislabeled or packaged poorly. Sometimes a medicine is recalled because of confusing dosing

instructions or a problem with the dosing tool provided with the drug.

Potentially contaminated During production or distribution, a medicine may become contaminated with

a harmful or non-harmful substance.

Not what it says. For example, you may think you are taking a pain reliever based on the package

material, when in fact what is inside the box is something else.

Poorly manufactured. Manufacturing defects related to a product’s quality, purity, or potency may be to

blame for a drug recall.

WHEN IS A DRUG RECALL ANNOUNCED?

A drug recall occurs when a prescription or over-the-counter medicine is removed from the market

because it is found to be either defective or potentially harmful.

WHAT TO DO IF A DRUG YOU’RE TAKING IS RECALLED

If the recall involves an over-the-counter drug, stop taking it at once. You can return the product to the

place of purchase and ask for a refund - stores generally have return and refund policies when a recall

has been issued.

Your doctor or pharmacist can recommend an alternative medication to use during the recall.

Manufacturers will also provide a hotline number to contact for more information.

If the recall involves a prescription drug, seek advice from your doctor or pharmacist as soon as possible

to find out what replacement is needed.

HERE ARE SOME TIPS TO KEEP IN MIND WHEN A DRUG IS RECALLED:

Don’t panic. Remember that most drug recalls are for minor issues. Seek your doctor’s advice. If you have taken a drug that has been recalled and have experienced

any unusual symptoms that you suspect may be linked to the medication, seek your doctor’s advice

immediately.

Safely discard recalled drugs. Even if you’re not currently taking the medication, check your medicine

cabinet for the recalled product and, should you have any, return it to your local pharmacy, which will

dispose of it safely.

Get educated. To find out more about drug recalls, visit the US Food and Drug Administration website

at www.fda.gov/Drugs/DrugSafety/DrugRecalls.

Regardless of whether or not your medicine has been recalled, if you ever notice anything unusual

about a medication or medicine bottle or wrapper, such as evidence of tampering, an odd smell or

contamination, notify your pharmacist before taking it.

Handwashing

Why wash your hands?

Handwashing is the easiest and most effective way of preventing infection and contamination. When should you wash your hands?

Before and after giving medication, it is very important to wash your hands. How?

• Place your hands under running water • Rub soap on your hands and wrists to loosen skin oils and surface dirt.

• Point your hands downward and rinse off soap under running water.

• Dry your hands with a clean paper towel.

Note: If hands become reddened or dry because of frequent washing, apply a hand lotion.

Sharp Object Disposal

You can help prevent injury, illness, and pollution by following some simple steps when you dispose

of the sharp objects and contaminated materials you use in administering health care in your home.

You should place the following in a hard plastic container.

• Needles • Syringes

• Lancets

• Other sharp objects

As a patient of Jefferson Specialty Pharmacy /Walnut Home Therapeutics, Inc. you may request a needle

disposal box (when warranted). Please let us know when it is 3/4 full. We will pick it up and replace it with

a new one. Make sure that you keep all containers with sharp objects out of reach of children and pets.

We also recommend that:

• Soiled bandages • Disposable sheets

• Medical gloves

be placed in securely fastened plastic bags before you put them in the garbage can with your other trash.

Please visit the Sharps Disposal Containers page at www.fda.gov for more information.

Emergency and Disaster Planning Home Safety Tips During times of severe weather or emergency conditions, you will be provided with care based on

priority of need. Scheduled patients will be contacted by phone and informed of the emergency plan

in progress. Twenty-four hour telephone assistance is available by calling the phone number identified

on the back page. In the event that you are in need of immediate medical attention, please contact

Emergency Medical Services by calling 911!

GENERAL DISASTER PREPAREDNESS

Plan Ahead

• Discuss emergency management tips with your nurse or pharmacist. If an emergency arises,

you will be prepared and will stay calm.

Be Prepared

• Have a battery operated radio available. Tune in for local emergency reports • Gather supplies:

- Water, food, first aid kit, flashlight or candles, batteries

- Any supplies or special equipment needed for your care

- Rock salt or cat litter for snow and ice emergencies

Keep in Touch

• Identify a neighbor who can give assistance in an emergency • Keep emergency numbers available

- Friends or neighbors who can assist

- Emergency response numbers

- Your utility companies

Contact the Agency

• If you have concerns or doubts about your emergency plan, call Jefferson Specialty Pharmacy/Walnut

Home Therapeutics, Inc.. • If you lose power, contact us if you have concerns that your medications were stored outside of the

proper temperature range.

• If you need to change your location due to emergency conditions, please let us know • In case of a power outage, if you require assistance and our agency phone lines are down, please

follow these directions

- If you are in a crisis or have an emergency situation, call 9-1-1 or go to the nearest hospital

emergency room.

- If it is not an emergency, but you need assistance, call your closest relative or neighbor.

Our agency will get in touch with you as soon as possible.

Natural Disaster or Federal Emergency

Follow the directives provided by the Emergency Broadcasting Network or the Federal Emergency

Management Association. Your local radio and television stations will broadcast specific directions for

personal and medical safety.

Snow and Ice Storms – Can be localized

Make arrangements for:

• Snow and ice removal. • Someone to get or to deliver groceries.

• Someone to check on your safety.

Expect utility loss. Have a plan for providing care without utilities.

FIRE SAFETY

If you are disabled, protect yourself by notifying the local fire department about your special needs. WIND STORM

Heed warnings and take cover.

• Close curtains or drapes. • Expect utility loss and the need to shut off utilities.

FLOODING

• Local floor wetting – Be sure equipment and supplies are kept in a clean and dry location • If the floor is wet, DO NOT TOUCH appliances, fixtures or switches.

• Deep water – plan for evacuation, plan for what equipment or supplies must be evacuated.

UTILITY LOSS

Loss of electricity, heat, water or other vital services.

• Call the emergency numbers for the utility companies with which you do business!

Home Safety: Preventing Fires and Burns

Check All Cords

• Keep cords from beneath furniture and rugs. • Overloaded extension cords may cause fires.

• Make sure that cords are in good condition, not frayed or cracked.

Check Smoke Detectors

• Fire departments recommend one smoke detector be located on each floor of the home. • Develop an evacuation plan to exit the dwelling in the event of fire or other emergency.

• Test your smoke detector every month and change the batteries every 6 months.

• Notify the fire department if you or a family member has a disability that prevents your evacuation.

Check the Bathroom

• Always check the water temperature before entering the bath or shower.

Check the Bedroom

• DO NOT smoke in bed. Check the Basement

• Use correct size fuses at all times. • Gasoline, paints, solvents, and other flammable liquids should be stored out of living areas and away

from heaters, furnaces, water heaters, ranges, and other gas appliances.

• Turn water heater temperature down to 115°F.

Oxygen Safety

Oxygen is a medicine ordered by your doctor. Oxygen is safe when used properly. Oxygen does not burn

or explode, but it will cause a fire to burn more quickly.

To reduce the risk of fire or other injury, exercise caution when using home oxygen: • Never smoke when using your oxygen. Do not allow smoking in the home, even when the oxygen is

turned off.

• Display a “Oxygen in Use- No Smoking” sign on the door leading into your home. • Keep flames, sparks, and flammable materials away from oxygen equipment. Never allow an open

flame in the same room.

• Do not use your gas or electric stovetop or oven while wearing oxygen. Keep gas and electric

equipment at least 10 feet away from the oxygen source.

• Never place your oxygen equipment near curtains or cover them with clothing or other material

objects. This will restrict air circulation and increase the oxygen concentration.

• Avoid using oil, grease, petroleum, or aerosols on or around your oxygen equipment or tubing. • Use water-based lubricants such as Surgilube to moisten your lips or nostrils. Do not use oil-based

products such as petroleum jelly (Vaseline).

• Turn off your oxygen when you aren’t using it. • Keep a working fire extinguisher in the room where oxygen is used.

• Keep children and pets away from oxygen equipment and tubing.

• Use the shortest oxygen tubing possible to avoid tripping, tube disconnections, and malfunction.

• Keep oxygen tubing clear and straight to ensure proper oxygen flow.

• Make sure that the oxygen equipment alarm can be heard from all locations in your home.

• Register with your local electric company if you have electrically powered equipment such as oxygen,

Bi-PAP, or mechanical ventilator.

• Notify your local fire department that you have home oxygen. • Know and keep the name and phone number of your oxygen provider readily available. Call them

promptly for any equipment problems or for replacement equipment.

• Keep a back-up supply of oxygen readily available and know how to use it.

SAFE OXYGEN STORAGE Oxygen Tanks

If you have compressed gas or liquid oxygen tanks, know how to store your oxygen equipment properly:

• Store tanks in an upright position.

• Secure tanks in crate, cart, or rack so they cannot be knocked over or fall. If cylinders cannot be safely

stored upright, lay them down to prevent them from falling over. Liquid oxygen units must always be

stored upright.

• Store oxygen tanks in a well-ventilated area away from sources of ignition or heat. Keep open space

around the tanks. Never store cylinders in unventilated places such as under beds, behind the bed, in

closets, in car trunks, or in a garage.

• Never store cylinders near heat or extreme cold, or in direct sunlight. • Keep oxygen tanks at least 10 feet from the following: Gas or electric cook top or oven, gas furnace,

water heater, kerosene heater, electric space heater, paint thinner, gasoline or kerosene, any source of

open flame/ spark such as a lighter, match, or open flame, electric hair dryer, or electric razor.

• When transporting a cylinder in the car, have it secured in its carrier lying down, or secure it in a seat

belt. Do not travel in a car or truck with loose tanks. Always open a car or truck window when traveling

with oxygen. Keep the amount of oxygen you carry in the car to a minimum. Avoid transporting large,

high capacity cylinders in your car.

• Open cylinder valve by hand and turn slowly. Do not use a wrench or other tool to loosen or tighten

the cylinder valve.

Oxygen Concentrator Plug the concentrator into a grounded electrical outlet. Do not plug other electrical items into the same

outlet. Do not use an extension cord.

• Keep open space around the concentrator. Do not restrict the airflow around the concentrator. Do

not place the concentrator in a closet, behind draperies, behind the bed, in a garage, or near a source

of heat or extreme cold.

• Do not use the concentrator as a table and or place items on top of it. • Clean the concentrator as instructed by your equipment provider, nurse, or therapist.

• Have backup oxygen tanks available and know how to use them.

• If an electric power failure occurs, turn off (or unplug) the concentrator to avoid an electric spark

when power is restored.

Other Oxygen Safety Tips:

Safety at Home: Tips to Prevent Falls

1. For safe footing, avoid the use of patterned, dark or deep-piled carpeting. If you drop something, pick

it up with an extended-reach grip device.

2. Keep wires and cords behind furniture and close to the wall. 3. Keep a flashlight near your bed where you can reach it. Consider using Velcro™ to attach it to the

nightstand or headboard.

4. Avoid pajamas or robes that are too long. 5. Avoid walking barefoot. Wear non-skid footwear.

6. If your feet swell, buy shoes in the afternoon to prevent buying shoes that are too tight. To prevent

dizziness, rise slowly after lying down or sitting.

7. If you feel dizzy, only get up with assistance. 8. Keep porches, driveways and walkways brightly lit.

9. Sprinkle rock salt or clay-type kitty litter on slippery sidewalks to give better traction. Light switches

should be at both ends of the hall and at the top and bottom of stairs. Place night lights around the

house, not just in the bathroom or hallway.

10. Equip bathtubs and showers with non-skid mats and adhesive strips to prevent slipping. Install grab

bars in the bathroom.

11. Keep throw rugs down with double-sided tape. Consider removing throw rugs completely. 12. Be sure furniture is sturdy and won’t topple easily. Avoid any furniture that has rollers.

13. Make sure that chairs, stools, sofas and beds are at the right height. You should be able to sit

comfortably with your feet flat on the floor.

14. Beware of coffee tables and footstools. They can be tripping hazards. Hand rails should be on both

sides of the stairways for support.

15. Place a phone where you can easily reach it while in bed. 16. A cordless or cellular phone can be carried from room to room in an apron pocket or a fanny pack.

To avoid rushing when the phone rings, consider installing phones in more than one room. 17. Get regular eye exams.

18. While walking, do not wear glasses that are meant for reading.

19. As we age, our eyes are slower to adapt from light to dark. Turn the light on before entering a room.

Have your ears checked regularly. Ears play an important role in helping with balance. 20. Keep your glasses clean.

21. Ask your doctor or pharmacist if any of your medications affect balance or coordination. Avoid

alcoholic beverages while on medication.

22. Consider keeping pets in designated areas at night. This can prevent pets from becoming tripping

hazards.

23. Train your pets not to get under foot or not to jump on people. Be careful of toys lying in your path. 24. Put your walker or cane where you won’t fall over them.

Preventing Heat Illness

What is Heat Illness?

• A collection of conditions including heat cramps, heat exhaustion, and heat stroke. • As the heat and humidity rise so does the number of cases of heat illness.

• Heat cramps are muscle spasms in the stomach, arms or legs which may begin during or after heavy

activity and may cause mild discomfort or severe pain.

• Heat exhaustion causes feelings of extreme weakness, nausea, vomiting, dizziness, and fainting and

the person’s skin turns pale, cold and moist with sweat.

• Heat stroke is a life threatening emergency which causes the person to lose consciousness, their skin

to become red, hot and dry. The body does not product sweat!

Who is at Risk for Heat Illness?

• Anybody is at risk for heat illness if exposed to the effect of heat and humidity for prolonged periods of

time without taking proper precautions.

• People who are at greater risk and should take greater precaution include:

- children

- obese persons

- elderly persons

- persons who work outdoors

- persons with chronic illnesses, such as heart or breathing problems

- persons taking certain medications (check with your nurse)

- persons with vomiting or diarrhea How can I Prevent Heat Illness?

• Drink plenty of cool water on hot summer days but check with your doctor for any fluid restrictions. • Reduce your physical activity and plan to do needed activities at cooler times during the day while

taking many breaks and periods of rest between activities.

• Always wear a hat when exposed to direct sun light. • Wear light-colored and porous clothing preferably cotton.

• Report any signs or symptoms of heat illness to your doctor immediately.

• Avoid alcoholic beverages.

• Avoid taking salt tablets unless ordered by your doctor.

• If you do not have air conditioning, keep your house well ventilated by keeping windows open and

using fans to keep the air circulating.

Preventing the Flu PROTECT YOURSELF

You can protect yourself from getting the flu this winter season by getting a flu shot. What is the Flu?

• A respiratory infection caused by a virus. • Commonly occurring from November through April.

• Usual symptoms are fever, chills, cough and muscle aches which can last from a few days to a week.

• Recovery is usual but complications such as pneumonia or death could develop.

What is Flu Vaccine?

• It is made from killed viruses. • IT DOES NOT GIVE YOU THE FLU.

• The viruses included in the vaccine change from year to year.

• Flu shots are given to adults by injecting into the muscle of the upper arm.

• The protective effects of the vaccine begin after about 1 to 2 weeks and last an average of several months.

Who should get the vaccine?

• Healthy people 65 and older. • Adults and children with heart and lung disease.

• People who have: kidney disease, diabetes, anemia, severe asthma, cancer, AIDS or HIV positive, or

persons who are taking medication that lowers the body’s normal resistance to infection.

• People who are most susceptible to become seriously ill or die from the flu or its complications. Who should not get the vaccine?

• People who have serious and dangerous allergic reactions to eggs. • Women who are pregnant.

• People who are presently acutely ill and have a fever.

• People who have had a previous attack of Guillian-Barre syndrome.

What kind of side effects are possible?

• Soreness at the injection site up to 48 hours. • Slight fever or achiness 1-2 days after injection.

• As with any drug or vaccine, serious reactions can occur.

Cold Weather Tips HOW CAN YOU HAVE A WARM AND WORRY FREE WINTER?

You can stay warm and safe by following a few safety tips.

Furnace Safety

• Have a qualified serviceman check your

furnace and clean it.

• Remove trash, papers or paint from the area

around the furnace.

• Use metal containers for ashes. Fireplace Safety

• Cover the fireplace opening with a sturdy

metal screen or heat-tempered glass door.

• Never leave fire unattended. • Before and after heating season, have qualified

personnel clean the chimney and check it for

crumbling bricks, loose mortar, obstructions,

and creosote buildup.

• Burn only dry, well-seasoned hardwoods like

oak and birch; avoid pine, spruce and wood that

is green and moist.

Woodstove Safety

• Recommend cast iron or heavy steel stoves

with a damper or draft control.

• There should be a minimum clearance of 36

inches between stove and walls and ceiling.

• Should be positioned on a base such as metal

or brick which extends 18 inches beyond stove

in all directions.

Portable SpaceHeaters

• Be sure heater shuts off if tipped over. • Never leave children unattended with heater.

• Be careful around kerosene heaters with

canister vacuum cleaners which can spread

flames onto carpets, drapes, etc.

• Do not use around explosive fumes or materials.

Cold Weather Fire Safety

• Make certain curtains and blankets do not

touch heaters.

• Never let vaporizer run dry. • Plug equipment into separate outlets or use

heavy duty extension cords.

• Never fold or roll an electric blanket; heat builds

up and the wires break, store flat and unplugged.

Smoke Detectors Save Lives

• Install a smoke detector on each level of your

home; especially outside of bedrooms.

• Keep smoke detectors dust free; change

batteries in the spring and fall when the

clocks change.

• Test smoke detectors once a month. Escape Planning

• Establish a fire escape plan. • Every room should have two ways out; make

sure windows open and are not painted shut.

• Try to find an exit that does not require opening

the bedroom door.

• Determine a meeting place for all household

members away from the house.

• If you suspect fire, get out and call the fire

department from a neighbor’s house.

• Never re-enter your home, it could cost

you your life.

Patient Bill of Rights

Jefferson Specialty Pharmacy/Walnut Home Therapeutics, Inc. protects and promotes your rights as a

patient under its care. You may exercise these rights at any time while under our care, or you may have a

family member or guardian exercise these rights if you are unable. You have the following rights to:

1. Receive written information and be fully informed of all your rights and responsibilities while under

our care.

2. Be treated with dignity and to have your property treated with respect at all times. 3. Receive services without discrimination due to age, AIDS or HIV status, ancestry, color, culture,

disability, education, gender identity, income, language, marital status, national origin, race, religious

creed, sex, sexual orientation, union membership, or who will pay your bill.

4. Receive a comprehensive assessment including evaluation of comfort, nutrition and pain

management.

5. Receive information in a way that you understand. This includes interpretation and translation, free of

charge, in the language you prefer for talking about your health care. This also includes providing you

with the needed help if you have vision, speech, hearing, or cognitive impairments.

6. Privacy and to have all of your records pertaining to your care treated in a confidential manner.

Information concerning your care will not be released without your written consent or as required by

law.

7. Refuse care within the confines of the law and be informed of the consequences of your actions. 8. Right to request a change in caregiver without fear of reprisal or discrimination.

9. Make decisions about your medical care, including the use of advance directives.

10. Receive care without regard to whether you have or have not executed an advance directive.

11. Be fully informed of our policies and charges for service, including eligibility for third party

reimbursement and the extent to which payment may be required from you.

12. Be fully informed, within 30 days of the date we become aware, of any changes in your payment

responsibility.

13. Participate in the planning of your care and to receive information necessary to give informed

consent prior to the start of your care.

14. Know who the persons are who will be providing care, what their roles are in your care, what type(s)

of care each will provide and the frequency of care. 15. Voice grievances regarding care that is (or fails to be) provided, or regarding a lack of respect to your

property without fear of reprisal or discrimination. To lodge a complaint with us, call 215-955-5200

and ask for the director of Walnut Home Therapeutics, Inc..

16. Be informed about the disposition of your grievance or complaint. 17. Be informed of the availability of oversight agencies for patient safety and quality concerns. Jefferson

Specialty Pharmacy/Walnut Home Therapeutics, Inc. encourages patients and families/significant others

to share concerns about patient safety and quality of care with the organization. If these concerns are

not addressed, Jefferson Specialty Pharmacy/Walnut Home Therapeutics, Inc. recommends that the

organization’s management be contacted. Concerns that cannot be resolved through this manner may

be communicated to The Joint Commission at a toll free hotline number - 800-994-6610 or email at

complaint@jointcommission.org.

Patient Responsibilities

Jefferson Specialty Pharmacy/Walnut Home Therapeutics, Inc. protects and promotes your rights as a

patient under its care. As a Jefferson Specialty Pharmacy patient/caregiver you have the responsibility to: • Give accurate and complete health information concerning your past illnesses, hospitalizations,

medications, allergies, present complaints, and other pertinent items.

• Inform us of perceived risks and/or changes in your health status including any problems you are

experiencing with the use of the medication we are providing.

• Assist in providing and maintaining a safe and healthy environment. • Notify us in advance when you need to change a scheduled delivery or shipment.

• Participate in the planning of your care and make decisions about your medical care including the use

of advance directives.

• Follow your care plan and inform us of any concerns about your ability to follow the plan. • Accept consequences for your outcome if you do not follow the care, treatment, and service plan.

• Request further information concerning anything you do not understand.

• Inform us regarding concerns or problems you are experiencing.

• Inform us of any changes you make in your health insurance coverage. Failure to notify the Agency

may result in services not being covered by your insurance. You will be billed for these services.

• Meet any financial obligation agreed to with Jefferson Specialty Pharmacy/ Walnut Home

Therapeutics, Inc.. • Follow our rules and regulations.

• Show respect and consideration for Jefferson Specialty Pharmacy staff and property.

• Bring your medication list with you to all health care settings, including emergency department and

doctor visits.

Please ask your pharmacist if you need further information about your responsibilities as a Jefferson

Specialty Pharmacy patient.

Rights and Responsibilities cont’d

Patients participating in our “Patient Management Program” have the following rights and responsibilities: • The right to know about the philosophy and characteristics of the patient management program

• The right to have personal health information shared with the patient management program

only in accordance with state and federal law

• The right to identify the program’s staff members, including their job title, and to speak with

a staff member’s supervisor if requested

• The right to speak to a health professional • The right to receive information about the patient management program

• The right to receive administrative information regarding changes in, or termination of,

the patient management program

• The right to decline participation, revoke consent, or disenroll at any point in time • The responsibility to submit any forms that are necessary to participate in the program,

to the extent required by law

• The responsibility to give accurate clinical and contact information and to notify the

patient management program of changes in this information

• The responsibility to notify your treating provider of your participation in the patient

management program, if applicable.

Medicare DMEPOS Supplier Standards

Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must

meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in

42 C.F.R. 424.57(c). • A supplier must be in compliance with all applicable Federal and State licensure and regulatory

requirements and cannot contract with an individual or entity to provide licensed services.

• 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.

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

privileges.

• 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 nonprocurement programs.

• 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.

• 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. • A supplier must maintain a physical facility on an appropriate site. This standard requires that the

location is 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.

• 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.

• 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.

• 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.

• A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions

allowed. This standard prohibits suppliers from contacting a Medicare beneficiary based on a

physician’s oral order unless an exception applies.

• A supplier is responsible for delivery and must instruct beneficiaries on the use of Medicare- covered

items, and maintain proof of delivery.

• A supplier must answer questions and respond to complaints of beneficiaries, and maintain

documentation of such contacts.

• 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.

• 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.

• A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-

covered item.

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

in the supplier.

• 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.

• 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.

• 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.

• A supplier must agree to furnish CMS any information required by the Medicare statue and

implementing regulations.

• 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 for those

specific products and services (except for certain exempt pharmaceuticals). Implementation Date -

October 1, 2009

• All suppliers must notify their accreditation organization when a new DMEPOS location is opened. • All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards

and be separately accredited in order to bill Medicare.

• All suppliers must disclose upon enrollment all products and services, including the addition of new

product lines for which they are seeking accreditation.

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

Implementation Date - May 4, 2009 • A supplier must obtain oxygen from a state-licensed oxygen supplier.

• A supplier must maintain ordering and referring documentation consistent with provisions found in

42 C.F.R. 424.516(f). • DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare

providers and suppliers.

• DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain

exceptions.

Notice of Privacy Practices HIPAA PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES: THOMAS JEFFERSON UNIVERSITY, THOMAS JEFFERSON UNIVERSITY

HOSPITALS, INC. AND JEFFERSON UNIVERSITY PHYSICIANS

A notice of our Privacy Practices are available on line at: Privacy Practices - Jefferson University Hospitals

hospitals.jefferson.edu/patients-and-visitors/.../privacy-practices.html Online Privacy Statement - Jefferson University Hospitals

hospitals.jefferson.edu/patients-and.../online-privacy-statement.html If you would like a written copy of these practices please notify our office directly and we will provide

you with one.

If you have a question or wish to file a complaint about your health care information privacy,

please contact the Jefferson Health – Center City Privacy Office at 215-503-6300, or email us

at centercityprivacyoffice@jefferson.edu, or contact us by mail at:

Jefferson Health – Center City

111 South 11th Street

Philadelphia, PA 19107

Attention: Privacy Officer

If you wish to remain anonymous, contact the Jefferson Alert Line at 833-ONE-CODE (833-663-2633) or

Jefferson.MyComplianceReport.com.

TJUH System includes TJUH, Inc., (the Center City Campus, Methodist Hospital Division, Jefferson Hospital for Neuroscience), JeffCARE,

Inc., Riverview Surgery Center at the Navy Yard, LLC, Riverview Surgery Center at the Navy Yard LP, Jeffex, Inc., Emergency Transport

Associates Inc., Walnut Home Therapeutics, Inc., TJUH Health Affiliates, Jefferson University Physicians, Jefferson Medical Care,

Methodist Associates in Health Care, Inc. (d/b/a Jefferson Community Physicians), The Atrium Corporation and Healthmark, Inc.

Guidelines for Using the On-Call System

OFFICE HOURS: MONDAY THROUGH FRIDAY 8 A.M. TO 5 P.M.

A pharmacist is available by telephone after hours and on weekends

The on call pharmacist can be accessed through our main number: 844-469-7542

HOW TO CONTACT THE ON-CALL PHARMACIST

1. After 5 p.m. and on weekends you are connected to the answering service.

2. State your name and phone number. Give a description of the issue to operator.

3. The operator will contact the on-call pharmacist.

4. The on-call pharmacist will return your call as soon as possible.

5. If you do not hear from the pharmacist within 30 minutes, call the answering service again.

6. You may call our 24 hour number: 844-469-7542

IF IT IS A MEDICAL EMERGENCY CALL 911

• Unrelieved chest pain

• Severe shortness of breath

• Fall with inability to get up or to use arms and legs

• Unresponsiveness

• Bleeding

Patient Comments or Concerns:

How do you feel about our services? We would like you to tell us. You may either complete this form or

call us at the number listed below. We would also like to have your ideas regarding how we can improve

your experience while at home on our service.

As stated in your Patient Bill of Rights, you have the right to be given appropriate and professional

services. Please share your thoughts.

Call: Walnut Home Therapeutics, Inc. at 844-469-7542 and ask for the director. You will receive a Patient Survey at the completion of your care. It is very important in maintaining

our quality standards that you complete the survey. We appreciate your opinions.

Thank you for your comments. Please include dates, times and names, if possible.

Name: Patient’s Name:

Send comments/concerns to:

Walnut Home Therapeutics, Inc., Director

919 Walnut Street, Suite 501

Philadelphia, PA 19107

Main: 844-469-7542

CS

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NOTES AND COMMENTS

Jefferson Specialty Pharmacy

919 Walnut Street, Suite 501

Philadelphia, PA 19107

Specialty.Pharmacy@Jefferson.edu | 844-469-7542