Patient/Client Rights

Parent or Guardian First Name:*
Parent or Guardian Last Name:*
Phone Number:*
Email Address:*
Client's Name:*
Individuals receiving services at EBS Children’s Institute have both rights and responsibilities. Clients and participants will be educated about their rights and responsibilities in a variety of ways (i.e. written form upon intake documentation, by staff throughout assessment process).
1. Patients/Clients have the right to be treated with dignity and respect.
2. Patients/Clients have the right to fair treatment, regardless of race, ethnicity, creed, religious belief, sexual orientation, gender, age, health status, or source of payment for care.
3. Patients/Clients have the right to have their treatment and other patient information kept private. Only by law may records be released without patient permission.
4. Patients/Clients have the right to access care easily and in a timely fashion.
5. Patients/Clients have the right to a candid discussion about all their treatment choices, regardless of cost or coverage by their benefit plan.
6. Patients/Clients have the right to share in developing their plan of care.
7. Patients/Clients have the right to the delivery of services in a culturally competent manner.
8. Patients/Clients have the right to information about the organization, its providers, services, and role in the treatment process.
9. Patients/Clients have the right to information about provider work history and training.
10. Patients/Clients have the right to information about clinical guidelines used in providing and managing their care.
11. Patients/Clients have a right to know about advocacy and community groups and prevention services.
12. Patients/Clients have a right to freely file a complaint, grievance, or appeal, and to learn how to do so.
13. Patients/Clients have the right to know about laws that relate to their rights and responsibilities.
14. Patients/Clients have the right to know of their rights and responsibilities in the treatment process, and to make recommendations regarding the organization’s rights and responsibilities policy.
15. Patients/Clients have the right to access to information/records in sufficient time to facilitate decision making.
16. Patients/Clients have the right to freedom from abuse, exploitation, retaliation, humiliation, and neglect.
17. Patients/Clients have the right to informed consent or expression of choice regarding release of information, service delivery, composition of service, delivery team, and concurrent services.
18. Patients/Clients have the right to information on investigation and resolution of alleged infringement of rights.
19. Patients/Clients have the right to receive, provided on request, an accurate and current set of professional credentials of practitioners working with the clients.
By signing below, I affirm that I have received and reviewed the patient/client rights policy.
Name:*
Relationship to Client:*
Date*
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