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Overview: The objectives of this course will be to go over the specific risks associated with business associates as it relates to HIPAA compliance. I will uncover myths versus reality as it relates to this very enigmatic law based on over 600 risk assessments performed as well as years of experience in dealing directly with the Office of Civil Rights HIPAA auditors. Times have changed and unfortunately many businesses are losing clients or unable to get new clients due to problems with their compliance program or lack of a compliance program. I will demonstrate from real life audits conducted by the Federal government what your highest risks are for being fined (some of the risk factors may surprise you). In addition this course will cover the highest risk factors for being sued for wrongful disclosures of PHI and the manner in which patients are now using state laws to sue for wrongful disclosures. States are being encouraged by the Federal government to implement new laws to remedy their citizens. Why should you Attend: Protect your business! Business associates are now required to comply directly with the HIPAA legislation! Many businesses are losing clients or unable to get clients because of compliance issues. We will be discussing the changes taking place in Washington DC with the Health and Human Services in relating to new risks business associates face under HIPAA. I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for the audit and deal with the Feds Areas Covered in the Session: Updates for 2016 What to do if a client requires more than just a signed business associate agreement Fines Policy and Procedure Who Will Benefit: Any business associates who work with medical practices or hospitals (i.e. billing companies, transcription companies, IT companies, answering services, home health, coders, attorneys, etc) Speaker Profile Brian Tuttle is a Certified Professional in H

A Basic Understanding of Shipyard Workplace Safety Shipyard Workplace Safety is a high importance, high criticality area for safety regulation. This is so because shipyards are among the most hazardous of places to work in. it is estimated that at any point of time, the number and incidences of injuries and fatalities in the shipyard industry is at least twice that of the next most hazardous industry, construction. This calls for urgent and important Shipyard Workplace Safety regulations. Present Shipyard Workplace Safety Regulations OSHA has a number of Shipyard Workplace Safety regulations for this industry. These need to be read with CFR Title 29 Code of Federal Regulations (CFR) Part 1915, which not only lay out regulations, but also prescribe codes and methods of implementation of these regulations. Why these two regulations need to be implemented together is that there may be a few hazards not covered by Shipyard Industry standards set out by OSHA. These gaps are covered by the regulations set out in CFR 1915, making these a well-rounded set of regulations for Shipyard Workplace Safety. The need for Shipyard Workplace Safety regulations The need for Shipyard Workplace Safety is acutely felt because of the sheer variety of hazards that present themselves in shipyards. Shipyards, which employ between a few dozen and a few thousand employees each, are a site of potentially serious accidents. Even if accidents do not occur, the very nature of work done at these shipyards can be dangerous and hazardous. Shipyard Workplace Safety is a core requirement that employers in this industry have to keep in mind and put in place. The nature of their work could range from and include any or many of these: Scrapping Demolition Electrical Fabrication Creating large and heavy steel or iron plates, sheets, beams, pipes and related items Soldering Drilling Dealing with propulsion systems Welding Shipyard Workplace Safety has to begin with an understanding of these issue

Quality Management in Healthcare: Quality management in healthcare is a critical requirement for healthcare organizations. Making quality management patient-centric comes first. Adapting and implementing standards and tools is the next step towards this. Quality management in healthcare is of critical importance to the healthcare industry and the patient. Everyone in the loop -from physicians to practitioners to support staff -needs to be aware of the importance of quality management in healthcare. The most basic purpose of imparting high quality management in healthcare is to make sure that the patient is well taken care of. For this to happen, the healthcare setting has to implement systems and processes. Quality management centers on process management. If organizations have to ensure that meaningful quality management in healthcare is being implemented; they have to adhere to processes. Adapting standards and instilling processes into the healthcare system is how healthcare providers can assure quality in healthcare. Patient is at the center of quality management in healthcare Obviously, the first step in the direction of implementing quality management in healthcare is to make the healthcare setting's care and processes patient-oriented and patient-centric. Quality management in healthcare begins with the patient and should be fully tuned to her needs. As patients' requirements and expectations vary over time; quality management has to keep upgrading itself to keep up with the changing needs and demands. In line with this, the following means can go a long way in ensuring quality management in healthcare: The healthcare setting has to identify goals for ensuring quality management in healthcare. Each department has to be given measurable goals to reach. Implementing quality standards goes a long way in ensuring that quality management in healthcare is imparted in the organization. Six Sigma, ISO 9001 and ANOVA are some of the popular standards a

Quality Management in Healthcare: Quality management in healthcare is a critical requirement for healthcare organizations. Making quality management patient-centric comes first. Adapting and implementing standards and tools is the next step towards this. Quality management in healthcare is of critical importance to the healthcare industry and the patient. Everyone in the loop -from physicians to practitioners to support staff -needs to be aware of the importance of quality management in healthcare. The most basic purpose of imparting high quality management in healthcare is to make sure that the patient is well taken care of. For this to happen, the healthcare setting has to implement systems and processes. Quality management centers on process management. If organizations have to ensure that meaningful quality management in healthcare is being implemented; they have to adhere to processes. Adapting standards and instilling processes into the healthcare system is how healthcare providers can assure quality in healthcare. Patient is at the center of quality management in healthcare Obviously, the first step in the direction of implementing quality management in healthcare is to make the healthcare setting's care and processes patient-oriented and patient-centric. Quality management in healthcare begins with the patient and should be fully tuned to her needs. As patients' requirements and expectations vary over time; quality management has to keep upgrading itself to keep up with the changing needs and demands. In line with this, the following means can go a long way in ensuring quality management in healthcare: The healthcare setting has to identify goals for ensuring quality management in healthcare. Each department has to be given measurable goals to reach. Implementing quality standards goes a long way in ensuring that quality management in healthcare is imparted in the organization. Six Sigma, ISO 9001 and ANOVA are some of the popular standards a

Course "New HIPAA Audit and Enforcement Activities: Being Prepared to Show your Compliance " has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: We will be discussing the history and evolution of HIPAA Privacy/Security and the major points you need to understand to proactively protect your practice or business from the imminent federal auditing process: * History of HIPAA * HITECH * HIPAA Omnibus Rule * How to perform a HIPAA Security Risk Assessment * What is involved in a Federal audit and how is it conducted * Risk factors for a federal audit * How to avoid a Federal audit * Business Associates and HIPAA audits * EHR and HIPAA * Business Continuity/Disaster Recovery Planning * Assessing your contractors and sub-contractors * In depth discussions on IT down to the nuts and bolts * Risk factors that can cause an audit (low hanging fruit) * New rules which grant states ability to sue citing HIPAA on behalf of a patient * New funding measures Why should you attend : The evolutions of this enigmatic law and how what was once relative benign in terms of enforcement is now fully funded and aggressive. Learn what you can do to be prepared for an audit and how to lower risks of ever being audited. It is absolutely imperative that you are proactive and not reactive with your compliance program, this is a necessary evil and you need to protect your practice or your business and limit risks from the imminent Federal audits. Join me in keeping up with this very confusing law and take advantage of all the templates and information provided as part of the seminar. Areas Covered in the Session: * HIPAA -Brief History * HIPAA Privacy Rule vs HIPAA Security Rule * HITECH Act * Breach Notification Rule * Omnibus Rule and audits * Business Associates and audits * Current Court Cases (precedence) * Paper Based PHI Concerns and how to lower risk

Overview: I will be talking to specifics of HIPAA and the emergency room setting, do's and don'ts as well as dispelling myth vs reality. This lesson will be addressing how compliance officers need to get their HIPAA house in order as HIPAA is now fully enforced and the government is not using kid gloves any more. It will also address major changes under the Omnibus Rule and any other applicable updates for 2016 and beyond. There are an enormous amount of issues and risks for hospitals these days especially with the new legislation involving patient cash remedies for wrongful disclosure. I will speak on specific experiences from over 17 years of experience in working as an outsourced compliance auditor, expert witness on HIPAA cases within the ER, and thoroughly explain how patients are now able to get cash remedies for wrongful disclosures of private health information. More importantly I will show you how to limit those risks by simply taking proactive steps and utilizing best practices. Why should you Attend: What can and can't we do in the hectic emergency room with patient information? What are the new liabilities involved? How can we ensure security but also ensure patient care? This once rarely enforced law has changed and you need to know what's going on! What factors might spurn a HIPAA audit? …are you doing these things? Why are the Feds enforcing after all these years? State laws are now also more strict increasing liability for patient remedies! We will be discussing some of the changes taking place in Washington with the Health and Human Services in regards to the enforcement of the HIPAA laws already on the books. I will go over some of the new changes specifically affecting the emergency room setting I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for a potential audit Areas Covered in the Session: Updates for Omnibus Emergency Room Do's and Don'ts in the ER Ambulato

The federal Health Insurance Portability and Accountability Act (HIPAA) was legislated in 1996 with the primary aim of ensuring that employees who are in the process of changing or leaving their jobs do not lose their health insurance benefits. Additionally, HIPAA sought to bring down health care fraud and abuse by mandating pan-industry standards for the protection of health care information and automated billing and other related processes, and for ensuring the security of Protected Health Information (PHI). What is a HIPAA Security Audit? A HIPAA Security Audit is a program under the HIPAA Privacy, Security, and Breach Notification Audit Program of the Office of Civil Rights (OCR). A HIPAA Security Audit is carried out to make sure that the policies, processes and controls on the part of Covered Entities comply with the provisions of the HITECH Act of 2009. Adherence to the requirements laid out by HITECH is mandatory. Given the high degree of continued use of new technologies that go into and will continue to go into electronic records of patients and the criticality of the data contained in them; the US Department of Health and Human Services (HHS) recognizes that there could be chances of data breach of Protected Health Information. It is to prevent the occurrence of these breaches that a HIPAA Security Audit is mandated by the HITECH Act. Reporting of data breaches is mandatory The foremost highlight of the HITECH Act is the requirement that Entities covered by HIPAA report data breaches that affect 500 or more employees to the HHS. The OCR lays out an Audit Protocol, with whose policies, protocols and processes a facility has to comply if it is said to be compliant with the HIPAA Security Audit. Why is it necessary to carry out a HIPAA/HITECH Security Audit? Compliance with HIPAA Security Audit is necessary to demonstrate that a practice or business is well protected. The most important reason for which such entities need to be HIPAA/HITECH Security

Wheelchair with comfortble reclining back headrest. This wheelchair allows the user to obtain a more comfortable position, equally for those who are unable to sit at 90 degrees, but need to lie back. Options include elevating legrests and cushioning. This type of Wheelchair is a superb light weight aluminium total care chair with all the actions one would wish. All fully adjustable, tilt in space, reclining back, multi positional headrest,elevating legrests and full pressure cushioning. The reclining deluxe manual wheelchair. This wheelchair has all the features one would need in a wheelchair, fully adjustable arms, legrests, reclining back and pop off wheels. To remove the wheels simply press the button in the centre of the wheel and slide them off. Ideal for those who need to recline in the wheelchair as the back rest on this wheelchair can be adjusted to any position. With cushions, elevating legrests and other options, this wheelchair can be configured to meet most needs. This chair does not have tilt in space mechanism or pressure care cushioning, for this must look to the tilt in space chair. Comfort and positioning tilt-in-space wheelchair which is durable, modern looking and comfortable. It offers adjustable seat height and depth, back height, length adjustable armpads and infinite recline and tilt. The multifunction tilt in space wheelchair focuses heavily on the need of each individual user which is why it has many adjustments in one frame to make sure it can alter to cater individual requirements. One of the main features of this chair is its tilt in space feature, which allows a step less adjustment of the backrest and the seat angle. This is easily operated from the push handle and can be quickly adjusted when needed. The design of the backrest and seating on the wheelchair helps ensure comfort and support for the user. Wheelchair comes with elevating leg rests fitted as standard which again are step less and easily adjusted. There is also the o

Course "Validation and 21 CFR 11 Compliance of Computer Systems: Intermediate to Advanced" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: Computer Systems Validation (CSV) also known as Software Validation is all-pervasive in the Life Sciences Industry. It is a requirement of all the predicate rules, as well as 21 CFR 11 and Annex 11. However, unless one knows how to implement CSV, it is often very hard to detect the requirement for CSV, and very hard to determine what needs to be done, to meet domestic and / or international regulations or business continuity requirements. In addition, the FDA has stepped up 21 CFR 11 inspections that include CSV. This course will build on the Validation and 21 CFR 11 Compliance Basic Course, to give hands on experience on executing on the computer systems validation of a system, and to discuss related activities such as Validation Master Plan, Infrastructure Qualification, Project Management for Validation and Validation of Test Tools The attendees must have attended the Basic Validation & 21 CFR 11 Compliance. This is a very hands-on class and the attendees will be expected to use templates provided in the class to create the complete package for the validation of a system The Seminar: This Hands-On course will provide the attendees with more detailed experience on validation / 21 CFR 11 compliance of a computer system, as well as details for activities associated with computer systems validation as follows: 1. Validation Master Plan 2. Complete Validation for a System 3. Excel Spreadsheet Validation 4. Change Control 5. SOPs 6. Test Tools Validation 7. Project Management for Validation Who Should Attend : * VP of IT * Director of IT * Quality Managers * Project Managers (for CSV / IT) * Validation Specialists * Database Administrators * System Administrators * Directors / Senior Directors of Discovery * Directors /

Course "Validation and 21 CFR 11 Compliance of Computer Systems: Intermediate to Advanced" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: Computer Systems Validation (CSV) also known as Software Validation is all-pervasive in the Life Sciences Industry. It is a requirement of all the predicate rules, as well as 21 CFR 11 and Annex 11. However, unless one knows how to implement CSV, it is often very hard to detect the requirement for CSV, and very hard to determine what needs to be done, to meet domestic and / or international regulations or business continuity requirements. In addition, the FDA has stepped up 21 CFR 11 inspections that include CSV. This course will build on the Validation and 21 CFR 11 Compliance Basic Course, to give hands on experience on executing on the computer systems validation of a system, and to discuss related activities such as Validation Master Plan, Infrastructure Qualification, Project Management for Validation and Validation of Test Tools The attendees must have attended the Basic Validation & 21 CFR 11 Compliance. This is a very hands-on class and the attendees will be expected to use templates provided in the class to create the complete package for the validation of a system The Seminar: This Hands-On course will provide the attendees with more detailed experience on validation / 21 CFR 11 compliance of a computer system, as well as details for activities associated with computer systems validation as follows: 1. Validation Master Plan 2. Complete Validation for a System 3. Excel Spreadsheet Validation 4. Change Control 5. SOPs 6. Test Tools Validation 7. Project Management for Validation Who Should Attend: * VP of IT * Director of IT * Quality Managers * Project Managers (for CSV / IT) * Validation Specialists * Database Administrators * System Administrators * Directors / Senior Directors of Discovery * Directors / Senior

A reclining wheelchair allows several key parts of the device, including the foot rests and backrest, to be adjusted to accommodate various needs and positions. Reclining wheelchairs are high back wheelchairs that allow the user to recline from a 90 degree position down to 180 degree position. Reclining wheelchairs have handbrake-like controls that release the back and lock it into place. Reclining wheelchairs are equipped with removable full support headrests, swing away elevating leg rests and padded arm rests for additional support and comfort. Like standard wheelchairs, reclining wheelchairs fold compactly for easy transport and storage. Different Types Of Reclining Wheelchairs: Reclining Wheelchair 902 GC Reclining Wheelchair 609 GC Karma Aurora 4 Reclining Wheelchair Karma Reclining Wheelchair KM 5000 Karma VIP 515 Wheelchair Reclining backrests can be a useful feature for children: Are unable to sit upright for sustained periods because of weak muscles in the upper body, or a stiff spine or hip. Have difficulty breathing. Are receiving treatment that require them to be in a reclined position. Karma Aurora 4 Reclining Wheelchair: Frame Style : Fordable Frame Material : Aluminium (Light weight) Seat Width (inches) : 18" Total width in wheel to wheel : 11" Rear Wheel Size : 24" Front Wheel Size : 7" Seat to floor height (inches) : 20" Seat Depth (inches) : 16" Back height (inches) : 35" Total height (inches) : 50" Max User Weight Capacity (kgs) : 120 Net Weight (kgs) : 13.5 k.g. Upholstery : Cloth water-proof. Armrest : Detachable, for easy transfer to bed. Leg-rest : Detachable, can also be elevated & with calf support for added comfort Wheel Quality : MAG WHEEL Rear Wheel Brakes : Available Hand brakes : Available Reclining Wheelchair Features: Lightweight aluminum wheelchair. Double crossbraces for extra strength. Folding frame. Padded detachable armrests with side panels. Length-adjustable leg supports. Punctu

Course "The A to Z's of HIPAA Privacy, Security, and Breach Notification Rules" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: This session is designed to provide intensive, two-day training in HIPAA compliance, including what's new in the regulations, what's changed recently, and what needs to be addressed for compliance by covered entities and business associates. The session provides the background and details for any manager of healthcare information privacy and security to know what are the most important privacy and security issues, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. Who Will Benefit: * Information Security Officers * Risk Managers * Compliance Officers * Privacy Officers * Health Information Managers * Information Technology Managers * Medical Office Managers * Chief Financial Officers * Systems Managers * Legal Counsel * Operations Directors Agenda: Day One Day one sets the stage with an overview of the HIPAA regulations and then continues with presentation of the specifics of the Privacy Rule, recent changes to the rules, and the basics of the Security Rule Lecture 1: Overview of HIPAA Regulations * The Origins and Purposes of HIPAA * Privacy Rule History and Objectives * Security Rule History and Objectives * Breach Notification Requirements, Benefits, and Results Lecture 2: HIPAA Privacy Rule Principles, Policies and Procedures * Patient Rights under HIPAA * Limitations on Uses and Disclosures * Required Policies and Procedures * Training and Documentation Requirements Lecture 3: Recent and Proposed Changes to the HIPAA Rules * New Penalty Structure * New HIPAA Audit Program * New Patient Rights

Course "Key Factors to Write an Effective Standard Operating Procedure (SOP) and Work Instructions (WIs)" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: Writing SOPs or procedural documents can be challenging at times. However, writing SOPs is overall a straightforward process. However, enforcing what you already created and implemented in the pipeline is another story. The term SOP is very obvious. We have seen "clearly written description of how specific tasks are to be done." Another satisfactory definition would be "detailed written instructions that achieve the uniformity of the performance of a specific function." Is the firm doing what the regulations specify? Is the firm doing what their procedures specify? If you are medical device or a pharmaceutical manufacturer, these definitions come as no surprise because when it comes to FDA regulations and guidance documents "establish" means to define, to document (in writing or electronically) and to implement. The goal and emphasis with FDA is simple. Proof of "Establish" is the foundation. Is the firm doing what the regulations specify? Is the firm doing what their procedures specify? Are the procedures being followed and enforced by company personnel? SOPs are needed in regulated industries to give step-by-step instructions for performing a particular job or task. This session will provide a step-by-step overview and a snapshot of the procedure description, the process and format. The subject matter of a SOP may range from how to operate a piece of machinery to how to log into a particular software program. SOPs ensure consistency and reliability because they require training of all affected parties. This session will address recent enforcement actions for SOP related violations but no surprise. Most of our enforcement actions are documentation related, i.e., SOP or other procedural documents. We will review examples from

What is Depression? Every individual experiences feelings of worthlessness, sadness, and negativity. It is when these feelings spiral out of control and consume the individual to an extent that his/her normal life is disrupted, that depression arises. Depression is a serious medical condition and can significantly weaken the individual both physically and mentally. What are the causes and risk factors of depression? In medical terms, depression is due to a decreased amount of certain chemicals in the brain. Depression has a genetic basis, i.e. depression may run in family. It can also be triggered by an event such as the loss of a loved one, losing a job, etc. There are some hormonal problems like decreased thyroid levels that can also lead to depression. Depression can also follow after the diagnosis of a serious illness and leads to impaired treatment of the disease. It is accompanied by the feeling of not getting well and hence ignoring the medication and the other activities that have been advised by the doctor. Risk factors Traumatic past, abuse, neglect Loss of a loved one Serious medical conditions like Parkinson's disease, etc. Also Read: How to Prevent Depression in Elderly What are the symptoms of depression? Persisting feeling of sadness, anxiety Low self-esteem Feeling worthless Pessimistic mindset Decreased appetite Difficulty in sleeping Oversleeping Inability to concentrate Talking, walking slowly Constantly feeling tired Loss of interest in activities that were previously enjoyable Decreased sexual desire Weight loss Headache Abdominal cramps Having ideas about death, contemplating suicide What are the investigations for depression? As such there are no investigations for depression. If the symptoms listed above continue for more than two weeks, the person is diagnosed with depression. Investigations advised by the doctor can be - Thyroid function tests Cortisol levels in the blood What is the treatment of depression? The treatment is both

Course "Supplier Management for Medical Device Manufacturers" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: Supplier selection and management is one of the critical issues for medical device manufacturers. Suppliers provide materials and services to the device manufacturer, which means that they can be critical to performance and delivery of your device. Neither the FDA nor your notified body regulates your suppliers (with a few exceptions). They expect you to have an effective process to ensure your suppliers perform in the regulatory environment. How well do you understand the requirements for supplier management? Could you pass a regulatory audit or inspection without any issues? This course delivers the tools, templates, and methods to help participants implement an effective and efficient supplier management program. This two-day hands-on course provides a clear understanding of the underlying principles of supplier management. The course uses exercises to solidify understanding. In addition, the course uses FDA Warning Letters to illustrate the points and help you learn from others. As part of the practical implementation, the course includes receiving acceptance activities, outsourced processes, process validation at the suppliers' location, supplier auditing techniques, and supplier issues in management review. The course uses the Global Harmonization Task Force (GHTF) framework, but expands it to cover other issues and techniques important in effective implementation. Why should you attend: Since FDA regulations do not allow them to audit your suppliers unless they make finished medical devices, they require that you have sufficient control over them. But from time to time the FDA makes a reinterpretation of what this means. This happened within the last f 5 years, so if you supplier management program is older than that, you need to make major changes in you supp

Cross-linked polyethylene, also known as PEX, XLPE or XPE, is a special type of polyethylene made from cross-linking polymer that can be bonded or pressed together at low temperatures, using heat to make it more malleable. It's most common use is in building materials, plumbing, gas and oil piping, insulation for heavy-gauge electrical cables and water heating systems. The polymers that make up PEX are called "Polypropylene""Polyisoprene". The cross-linking of the polymer molecules helps them form a strong bond when they're put together at high temperatures. PEX has many different uses, but the most popular among builders is in piping for plumbing systems, including plumbing fixtures like faucets, drains and showers. It can also be used in making water heater valves and lines, faucet pipes and joints, and drainage pipes for stormwater drains. Cross-linked polyethylene also has many other uses as well, including making pipe insulation, seals and adhesives for air conditioners, refrigerators and water heaters, and roofing materials. It's used to make the pipes that connect heating and air conditioning units to the rest of the house, as well as the ductwork between them. PEX pipes can also be used as a liner in place of Plexiglass to make an insulating layer on windows and doors, to block out cold air and warm sun-drenched air. The liner can also be used to cover vent pipes and to prevent moisture from building up on the interior of the house. This way, it acts as a "double layer" insulation, keeping the temperature and moisture level of the home in check. Read more @ https://coherentmarketinsights-cmi.blogspot.com/2020/12/vitamin-e-infused-highly-cross-linked.html

Reclining Wheelchairs are specially designed to allow a person to comfortably recline at incremental angles safely and comfortably. Typically used for accommodation of severe hip extension contractures, or thostatic hypotension, and pressure re-distribution for prevention of skin breakdown. Recliner Wheelchairs work better with Elevating Legrests (ELRs); the user's legs and feet can also be re-positioned for maximum comfort and health benefits. The "ELRs" are optional on some models and standard on others. Be sure to ask about which type of ELR is best suitable for seating and position needs. On some wheelchairs this is an option so be sure to check the options and accessories when purchasing. Reclining Back Wheelchair( bed cum wheelchair ) which are suitable for indoor as well as outdoor purposes. These wheel chairs are manufactured using high quality material to ensure high strength and durability. Wheelchairs are available in foldable frames and are capable for maximum weight. Reclining wheelchairs are available in standard folding frames with extended head supports and seat widths up to 24" wide. The recline mechanism is attendant operated with levers much like a bicycle brake lever. The levers operate hydraulic (pump) mechanisms for a smooth adjustment. Using this reclining mechanism, the chair back can easily and frequently be positioned to any angle. Flexible Back Positioning: Reclining chairs offer unlimited back re-positioning for more patient comfort, better blood circulation, and to aid in sleeping. Work best with ELRs: Recliner chairs need Elevating Legrest so the patients legs and feet can also be re-positioned for maximum comfort. On some chairs this is an option so be sure to check the options and accessories section of each product page. Only the Back moves: On recliner wheelchairs the back reclines but the seat bottom stays in-place. Karma Aurora 4 Reclining Wheelchair: Frame Style : Fordable Frame Material : Aluminium (