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FH-CL-004 • VERSION 1.0
Client Rights & Responsibilities
Plain-language rights, expectations and acknowledgment.
Digital workflow:
Complete required fields, review carefully, then submit. A submitted record is timestamped and preserved for office review.
1. Record identification
Client name *
Date *
Completed by *
2. Your rights
Rights reviewed *
Dignity and respect
Choice and independence
Know authorized services
Privacy and confidentiality
Professional boundaries
Control of money and property
Communication and complaints without retaliation
Emergency assistance
End services
3. Your responsibilities
Responsibilities reviewed *
Provide accurate information
Follow the Service Plan
Provide a reasonably safe environment
Treat personnel respectfully
Communicate schedule changes
Provide access
Protect funds and payment methods
Meet payment responsibilities
Keep emergency information current
4. Certification / acknowledgment
Electronic signature / typed name *
Signature date *
Notes
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