If you are a legal adult (at least 18 years old in this state), you have the right to request voluntary services. You have a right to:
A personal, individualized assessment of your needs
An individualized service plan, which will be reviewed regularly, developed with your input, and implemented with your consent
Services beginning within a reasonable time and ending when they are no longer needed or effective
Services even when you are unable (not unwilling) to pay (Ability to pay is determined by certain standard criteria.)
Another opinion regarding services provided (However, seeing someone outside of this setting is done at your own expense.)
Referrals to other competent professionals and sources of help as indicated by your service plan
Terminate service if your circumstances require it or you feel it is in your best interests, unless doing so puts you or others in grave danger
Resume service following termination.
You have a right to
Refuse any form of service or treatment unless it has been ordered by the court or in emergency situations when necessary to prevent harm to yourself and others (If you must receive services not by your own choice, you have the right to a lawyer, a court hearing, and an appeal of the decision to a higher court. If you cannot afford a lawyer, the court will appoint one for you.)
Refuse service with your primary clinician and request a referral to another setting
Be informed that without services, your situation may get worse
Refuse to take part in research studies without your written permission.
All information about you is understood to be confidential to protect your privacy. This information includes the fact that you have or have not received services. I am obligated to preserve your privacy to the extent permitted by law.
You have a right to
Determine the amount of information to be released, whether to or from anyone outside this setting, by signing a permission form
Sign a permission form to release information that is specific to each situation when information is to be released (You will not be asked to sign a “blanket” permission for release of information.)
Determine the length of time that information may be released and cancel your permission at any time (However, information may be released without your permission in a medical emergency to save lives, to prevent injury to yourself or others, or when required by law or ordered by the court.)
You have a right to
Courtesy, respect, and professionalism
Facilities that are comfortable and safe, promote dignity, ensure privacy, and contribute to positive outcomes of your service.
You have a right to verbal and written information about
Your rights, role, and responsibilities as a client in this setting
Your primary clinician’s rights, role, and responsibilities in this setting
What you can expect during your service process—appointments, costs, handling of emergencies, and other practices and procedures of this setting as they affect you
Any rights that are taken away and your right to a review of this action by requesting a Grievance Procedure
Your primary clinician’s credentials and professional code of ethics
Means to contact your primary clinician in both emergency and non-emergency situations
Procedures for reviewing your clinical records.
Any client or legal representative of a client may file a grievance as a formal notice of dissatisfaction regarding the operation of this service. The state regulatory board processes
grievances. Information about how to contact these organizations can be provided.