Client Rights and Responsibilities
What are my rights?
You have the right to:
- Receive accurate, easily understood information to assist in making informed decisions about health plans, facilities, and professionals.
- Receive mental health care in our programs regardless of your race, color, national origin, disability (physical and/or mental), sex, gender, gender identity or expression, affection orientation, marital status, military status, religion, or age. If you feel you have been treated unfairly or discriminated against for any reason, contact any of the following:
- Bacall Hincks, Program Coordinator 801-326-4390
- Medicaid’s Constituent Services, at 1-877-291-5583
- The Federal Office for Civil Rights at 1-800-368-1019, or e-mail contact: email@example.com, Web site: www.hhs.gov/ocr
- Obtain information about Children’s Service Society
- Be treated with respect and dignity.
- Have your privacy protected. Patients have the right to communicate with health care providers in confidence and to have the confidentiality of their individually-identifiable health care information protected. Patents also have the right to review and copy their own medical records and request amendments to their records.
- Receive information on treatment options and alternatives in a way that is clear and you can understand.
- Take part in treatment decisions about your mental health care, including the right to refuse treatment.
- Be free from restraint or seclusion, if it is used to coerce (force), discipline, or as a reaction (to retaliate), or for convenience, as specified in the Federal Regulations.
- Feel safe.
- Get a copy of your medical record, when allowed by federal law and if appropriate, ask for it to be amended or corrected.
What are my responsibilities as a client?
You are responsible to:
- Keep scheduled appointments.
- Cancel appointments 24 hours in advance.
- Be on time for your appointments.
- Participate with your therapist in your treatment plan and care.
- Tell your therapist of changes in your address, phone number, or insurance.
- Respect the property, comfort, and confidentiality of clients and staff.
- Notify your treatment provider when you want to stop getting services.
- Not smoke in the building in accordance with the Utah Clean Air Act.
- Assist in keeping Children’s Service Society a safe and secure environment by not displaying verbally or physically aggressive behaviors.
- Be free from the influence of drugs or alcohol during appointments. If, on two or more occasions, I appear intoxicated or under the influence of drugs or alcohol, I understand that a referral will be made to a substance abuse program.
- I understand that if I display threatening behaviors toward staff or other clients, referrals will be made to law enforcement and services will be terminated.
Client/Guardian Signature Date