Client Rights – Rae's Playze Adult Day Center

Clients Rights (Member)
Member Name:*
Member ID:
Medicaid Number:*
All members (clients) of Rae’s Playze Adult Day Health are entitled to the following rights:

To be treated with respect and dignity and be provided with courteous, professional care, without discrimination due to race, religion, gender, cultural practices, ethnicity, disability, sexual orientation or HIV status;

To obtain from the healthcare provider complete and current information about diagnosis, treatment and prognosis in terms that the patient can reasonably be expected to understand. When it is medically inadvisable to give such information to the patient, the information will be made available to an appropriate person on the patient's behalf;

To participate in decisions regarding their healthcare treatment and to have one's cultural beliefs and traditions respected in the treatment process.

To a safe environment with suitable privacy;

To know the names, credentials and positions of the people providing treatment;

To have fees and conditions of service explained to them at the time of service and to receive an itemized receipt for services rendered;

To have access to information concerning health education, self-care, and prevention of illness and to be informed of the personal responsibilities involve in seeking treatment and maintaining health and wellbeing;

To refuse treatment, and be informed of the potential medical consequences resulting from such a refusal;

To expect that communication and records pertaining to his/her healthcare are confidential and will be protected as such, except in such instances where disclosure is required by law;

To consent to or withhold consent regarding the release of confidential records and individually identifiable treatment information to outside parties; except in such instances where required by law. The process of consent and the option for refusal will be explained to clients upon requested;

To communicate any grievances or suggestions about the care or services received through the patient satisfaction survey, suggestion boxes or a patient advocate without being terminated from services;

To request a second opinion or a referral for a higher level of care;

To change healthcare provider if other qualified providers are available.

According to 10A NCAC 27D .0201 (1) (b) the client has the right to contact Disability Rights North Carolina, the statewide agency designed under federal and state law to protect and advocate the rights or persons with disabilities.

According to General Statue 122C-51. Each client has a right to treatment, including access to medical care and habilitation, regardless of age or degree of MH/IDD/SA disability.

The Patient has a Right and Responsibility:

• To give their practitioner complete and honest information about their past and present health, mental health and/ or addiction symptoms and to inform the practitioner of any lifestyle, health or mental health issues that could affect their health or the health treatment plan;

• To assist their health care provider in compiling a complete record by authorizing the heath center to obtain necessary information from appropriated sources;

• To inform their provider about any living will, medical power of attorney, or other directive that could affect their care;

• To understand and follow the treatment plan prescribed by their health care provider and to discuss any difficulties or questions that you might have adhering to the treatment plan or to following healthcare provider recommendations;

• To ask questions and seek clarifications regarding areas of concern; and to weigh the consequences of refusing to comply with instructions and recommendations;

• To act in a respectful and considerate manner with Heath Center personnel and patients;

• To arrive to their appointments on lime or give timely notice of cancelation. so that other patients may utilize that lime;

• To abstain from alcohol and/or the use of non- prescribed or illegal drugs prior to presenting for scheduled appointments as well as to use prescribed medication in the dosages recommended by their healthcare provider.

• To accept their role in managing their own wellness and to make choices in their daily life that reinforce the choice of wellness and balance in the areas of nutrition, appropriate sleep, physical activity and entertainment;

• To fulfill financial obligations for care and services at the time services are rendered;

• To perform all administrative functions with regard to filling his/ her insurances claims, whether via student health insurance or outside vendors.

• Rae's Playze is committed to providing Day Services within the community and is a strong advocate for the population; we serve and will ensure that each client understand their rights.

Your signature is required, acknowledging that you have been given a copy of these rights.
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Date*
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Clients Rights (Member)