CLIENT’S BILL OF RIGHTS AND RESPONSILITIES

There are fundamental rights granted to persons while receiving mental health services. These include but are not limited to, the following which are adapted from Florida Statutes 301.026, Civil Rights Act of 1964; The Americans with Disabilities Act of 1990.

RIGHTS OF INDIVIDUALS SERVED
1. To have access to treatment regardless of race, religion, sex, sexual orientation, ethnicity, age, or disability.
2. To have my personal dignity respected and receive considerate care that respects my personal value and belief system.
3. To continue to have legal rights to which all citizens are entitled, except as provided by law.
4. To know the identification of the clinical staff responsible for my care.
5. To participate in developing a treatment plan which is reviewed and implemented by qualified professional staff within the least restrictive environment.
6. To be informed of treatment procedures used; rules of conduct for individuals served; and discharge plans.
7. To be informed of the risks, side effects and benefits of treatment procedures used, and to be informed to alternate procedures.
8. To know the reasons for any proposed changes in treatment or for any transfer of care within or without the organization.
9. When refusing treatment, to be informed of the organization’s responsibility to seek legal alternatives or to terminate treatment based upon professional standards.
10. To be informed of the cost of services, sources of reimbursement, and limitations of services.
11. To be informed of my rights in a language I understand.
12. To be informed of my rights through appropriate communication if hearing or visually impaired.
13. To be informed of the use of observation and audio visual techniques.
14. To have personal privacy regarding visits from family and significant others, sending and receiving mail, and making telephone calls. (Will receive full explanation of any therapeutic restrictions in these areas).
15. To have personal privacy and confidentiality of communication with staff and of written records maintained.
16. To have the right to request the opinion of a consultant at one’s own expense, or to have an in-house review of the treatment plan.
17. To voluntarily participate in work activities as part of the treatment plan.
18. To refuse specific medications or treatment procedures to the extent permitted by law.
19. To refuse to participate in any research project without compromising access to the services of the organization.
20. To give written consent for use of audiovisual equipment or any treatment procedure where consent is required by law.
21. To participate in any research project by written informed consent.
22. To review the organization’s rules and regulations.
23. To request assistance with referrals.
24. To initiate a complaint or grievance procedure.
25. To meet with a License Mental Health Counselor in response to questions and/or concerns, call 352-861-4481

RESPONIBILITIES OF INDIVIDUALS SERVED
1. You are responsible for taking an active role in the outcome of your mental health care or your child(rens) care. This is done in part by providing to the best of your ability, accurate and complete information about present complaints, past illnesses, hospitalizations, medication, and other matters relating to psychiatric health: reporting unexpected changes in condition to the responsible practitioner; reporting whether you comprehend a contemplated course of action and what is expected.
2. You are responsible for following the treatment plan recommended by the primary therapist and responsible for your care.
3. You are responsible for keeping appointments and notifying the responsible primary therapist when you are unable to do so.
4. You are responsible for your actions if you refuse treatment for yourself and/or your family and do not follow the primary therapist recommendations and/or instructions.
5. You are responsible for following applicable policies affecting your care and conduct.
6. You are responsible for being considerate of the rights of others and for assisting in the control of noise, not smoking, and the number of visitors.
7. You are responsible for being respectful of the property of other persons and of Rapha Counseling Center.
I have read the statement of rights/responsibilities and/or it has been read to me. I have had an opportunity to ask questions and have them answered. I understand my rights/responsibilities and have been given a copy of this statement.
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Print Name Signature of Client, Parent or Guardian Staff Person/Witness Date