Rights
1. To receive services without regard to age, sex, race, ethnicity, religion, national origin, sexual orientation, gender identity, political affiliation, or disability.
2. To receive services that are considerate, respectful, and culturally sensitive.
3. To privacy. No information that would reveal my health status may be disclosed to anyone outside the agency without my informed, written consent as governed by local, state, and federal law.
4. To communicate about services in a language and format that is clear to me.
5. To be informed of al agency rules and regulations related to the provision of services.
6. To initiate a complaint about services and to be fully informed of the agency’s grievance procedure.
7. To withdraw consent for services and/or seek services at another agency without pressure or intimidation.
8. To know the qualifications of all staff providing services to me.
Responsibilities
1. To participate in the development and implementation of service/treatment plans to the extent that I am able.
2. To inform agency staff when I do not understand instructions or information.
3. To keep scheduled appointments, be in the clinic 30 minutes prior to my appointment and to notify agency staff when I need to cancel or reschedule.
4. To follow through with agreed upon activities and to notify agency staff when I am unable to do so.
5. To notify agency staff of services that you have obtained independently.
6. To keep agency staff informed about the quality, appropriateness and timelines of services that you are receiving.
7. To communicate my needs to agency staff as quickly as possible, understanding that they may not be able to satisfy all requests.
8. To conduct myself appropriately when interacting with persons involved in providing services. (Inappropriate behavior includes, but it is not limited to, intoxication, threats, harassment and physical or verbal abuse).
9. To notify the agency of any changes in my personal information including but not limited to name, address, home phone, cell phone, and insurance information.
Process for filing a complaint or grievance
You may exercise your right as a patient to file a complaint or grievance by the following steps:
Step 1: You should first address your question, complaint, or grievance to the person perceived as the source of the confusion or conflict. It is anticipated that most conflict will be resolved in this step. If not resolved by direct communication at the source of the problem, or if you do not wish to address the other person involved, you may proceed to Step 2.
Step 2: You may consult the department supervisor, explain the conflict, and solicit the supervisor’s intervention as a conflict resolution mediator. It is the duty of the supervisor to inform all involved parties of the conflict, collect information, conduct an investigation and interviews, and help facilitate a mutually agreeable resolution. You may appoint a representative as your advocate.
Step 3: You may consult a facility administrator or department director to explain the conflict and any resolution steps taken. You may request a meeting of all parties involved and solicit the assistance of the administrator as mediator. Notes of this meeting should be taken for documentation purposes and filed in your official record.
Step 4: You may choose to bypass Steps 1, 2, and 3, and initiate a grievance directly to the senior directors or chief executives. This step may be taken with or without the knowledge of the staff involved in the grievance. The grievance may be communicated in person or by telephone, e-mail, or letter. A letter or e-mail is preferred for the purpose of clear and unquestionable understanding. Grievances should be addressed to:
