• Statement of Client’s Rights and Responsibilities

  •  - -
    Pick a Date
  • Statement of Clients’ Rights

     

    Clients have the right to:

    ·         Be treated with dignity and respect.

    ·         Fair treatment; regardless of race, religion, gender, ethnicity, age, sexual

              orientation, disability, or source of payment.

    ·         Have treatment and other client information kept private. Only where

              permitted by law, may records be released without client permission.

    ·         Easily access timely care.

    ·         Know treatment choices regardless of cost or coverage by insurance plan.

    ·         Share in developing treatment plan.

    ·         Information in understandable language.

    ·         A clear explanation of condition and treatment options.

    ·         Information about Capstone, its practitioners, services, and role in 

              treatment process.

    ·         Information about clinical guidelines used in providing and managing care.

    ·         Ask provider about their work history and training.

    ·         Give input on this statement.

    ·         Know about advocacy and community groups and prevention services.

    ·         Freely file a complaint or concern and learn how to do so.

    ·         Know rights and responsibilities in treatment process.

    ·         Receive services that will not jeopardize employment.

    ·         Request certain preferences in a provider.

    ·         Have provider decisions about their care made without regard to financial

              incentives.

  • Statement of Clients’ Responsibilities

     

    Clients have the responsibility to:

    ·         Treat those giving care with dignity and respect.

    ·         Give providers information they need so they may deliver the best possible

              care.

    ·         Ask questions about care to assist in understanding care.

    ·         Follow the treatment plan. The plan of care is to be agreed upon by the

              client and provider.

    ·         Tell provider about medication changes.

    ·         Keep appointments. Call the provider as soon as possible if cancellation or

              rescheduling is necessary.

    ·         Let the provider know when the treatment plan is not working.

    ·         Report abuse and fraud.

    ·         Let the provider know about problems with paying fees.

    ·         Openly report concerns about the quality of care being received.

  • My signature below shows that I have been informed of my rights and responsibilities, and that I understand this information.

  • Clear
  • Should be Empty: