STATEMENT OF PATIENT RIGHTS

• To be entitled to respect and dignity in an environment that affords security and privacy.
• To receive services that are protected under the laws of confidentiality and to receive a Privacy Notice as well as other information concerning your rights regarding the use, storage and disclosure of healthcare information.
• To receive services regardless of race, sex, gender, gender identification, national origin, creed, physical or mental handicap, or personal ability to pay.
• To know the reasons for or purpose of the services provided and to consent to receiving these services.
• To receive an individual evaluation and treatment based upon your needs, abilities and goals, including your active participation in the development of your individualized treatment plan.
• To ensure that your needs and preferences are not neglected and to receive any information needed to make informed decisions concerning the services you receive.
• To be assessed fees on an equitable basis and to verify awareness of charges by signing a fee agreement.
• To express your preferences concerning the choice of case manager, counselor or other service provider.
• To review your records upon reasonable request and as provided by law.
• To refuse treatment or withdraw from services at any time without affecting re-entry later.
• To be free from physical abuse, sexual abuse, harassment and physical punishment imposed by program employees.
• To be free from psychological abuse, including humiliating, threatening and exploitive action on the part of program employees.
• To be free from financial abuse associated with program employees holding anything of value that belongs to you in order to get payment for treatment services.
• To be informed of the agency’s policy on no seclusion, and no use of restraint and to be informed of any restrictions of client rights.
• To receive assistance from the program in facilitating access and referral to appropriate resources; and
• To have privacy during visits unless contraindicated in the recovery and treatment process or as ordered by a physician or other authorized healthcare provider.
• You have the right to request a list of all information released to other facilities regarding your case.

No Surprise Act Notice