CLIENT RIGHTS AND RESPONSIBILITIES Each person served (and, where appropriate, his/her family and/or legal guardian) has the right to: 1. Reasonable access to services, regardless of race, creed, age, gender, physical abilities, national origin or sexual orientation. 2. Considerate and respectful services that respect your individual, culturally-defined needs, values and beliefs. 3. Be spoken with in words you understand and have reasonable access to an interpreter to ensure understanding. 4. Reasonable access to information in alternate formats and through assistive technology if you have special communication needs. 5. Participate in the planning and decisions of services to be provided and request a review of care, treatment or service plan. 6. Receive services in a manner that is non-coercive and protects your rights to self-determination. 7. Receive individually defined and appropriate services and supports. 8. Freedom of choice of services and supports and providers as applicable to programs. 9. Privacy and confidentiality including privacy in treatment and in personal care. 10. Be free from mistreatment, abuse, neglect and exploitation. 11. Not be humiliated, harassed or threatened and be free from chemical and mechanical restraints. 12. Refuse services, treatment, or medication (unless mandated by law or court order) and receive an explanation of possible consequences of refusing, including termination or discharge. 13. Be transferred or discharged if such action would be in your best interest or that of other clients, for lack of service progress or other circumstances, as well as the right to reasonable advance notice to assure appropriate and orderly transfer or discharge. 14. Know the rules and how you are expected to behave and expect consistent enforcement of program rules and expectations. 15. Know the cost of the service and not be turned down for service because of your inability to pay unless mandated by contracts. 16. Voice complaints/grievances at any time you feel your rights are not being respected or concerns not being addressed, utilizing CCH’s Client Grievance Procedures and free from interference, discrimination or retaliation. As a Client of a Catholic Charities Hawai‘i program, you have the responsibility to: 1. Treat other clients and staff with dignity and respect. 2. Listen carefully and participate actively, honestly and cooperatively in your services. 3. Ask questions about any policy, procedure, or service that you do not understand or with which you do not agree. 4. Be prompt for your appointments, or if unable to attend, to inform your program staff. 5. Accept responsibility for refusing services or failing to follow the program instructions. 6. Carefully read and understand any papers you may be asked to sign in relation to your services. 7. Fulfill financial obligations to Catholic Charities Hawai‘i. 8. Follow your program’s rules and regulations. 9. Be considerate of the rights and property of others. 10. Keep confidential any information you may obtain through group participation.
CLIENT CONFIDENTIALITY
At our agency we are aware of the sensitive nature of your situation. We will protect your right to privacy and confidentiality. We will keep what you tell us confidential and will not give out any information without your prior consent.
If we decide that we need to obtain information about you from some source other than yourself we can only do that with your written permission. When we receive inquiries from anyone outside the agency, or a request to observe you, interview you, take your picture, make audio or video tapes of you or your sessions or group meetings we will ask your permission in writing before responding to the inquiry or request.
All the information that you share with us, verbally or in writing is put into your record and locked away when it is not in use. The only people who may look at your record, without your written consent, are agency staff or other professionals who must use or process this information. You may look at your record at any time and you also may add any comments you wish. There are several occasions when we will disclose information about you or your case without your consent. These are: 1. The law requires us to report any known or suspected child or vulnerable adult abuse, neglect or exploitation. 2. If the court subpoenas your record we must release it. 3. If you are upset and might hurt yourself or others we will share that information with others to make sure you get the extra support and help you need. 4. In case of a serious medical emergency we may release information to secure your safety and well-being. Except for these few instances we will guard your privacy very carefully. We do not release, even with your consent, information about you that is provided to us by other sources. We ask people who request this information to request it from the source.
We at Catholic Charities Hawai`i hope you will benefit from our program of services and welcome you to our agency.
CLIENT GRIEVANCE PROCEDURE Catholic Charities Hawai`i (CCH) is dedicated to providing you with quality services. There may be times, however, when you are not satisfied with the services provided. A grievance is simply a formal complaint you wish to make about your case or the services you received from CCH without interference or retaliation. If you are dissatisfied with decisions concerning your case or services you have received, there is something you can do about it. You can file a complaint or an appeal. Here is what you can do: 1. Discuss your concerns with your CCH worker. If you and your CCH worker cannot resolve the problem to your satisfaction, tell the worker that you wish to speak with his/her supervisor. 2. The worker’s supervisor or Neighbor Island Community Director will schedule to meet with you and your CCH worker within five (5) working days to try and resolve the problem. If the problem is not resolved to your satisfaction after this meeting, you may write a letter outlining your grievance. If you wish, our staff will help you write the letter. Send the letter to: Rona Fukumoto, Division Administrator Catholic Charities Hawai’i 1822 Keeaumoku St. Honolulu, HI 96822 3. Within ten (10) working days of receiving your letter, the Division Administrator will contact you to discuss your concerns and will also talk with the parties involved. 4. After discussing the case and reviewing all matters relating to your grievance, the Division Administrator will decide on a resolution. You will be informed of the decision verbally and in writing within ten (10) working days after discussing the issue with you and a copy of this final decision will be filed in your case record. We truly hope that our staff can quickly resolve the problems you may experience. We believe that you deserve to receive the best service we can provide, and encourage you to voice your opinion without fear of retaliation.
CLIENT CONSENT FOR SERVICES
I understand in order to benefit fully from services I must willingly consent to receive services. I have been fully informed of my rights and responsibilities as a client, my rights of privacy and confidentiality, and my rights to make a grievance and how to go about grieving a complaint.
I understand I will be expected to keep appointments made with me in a timely fashion, to follow rules, regulations and guidelines of the program, to report any unusual changes in my physical or emotional state to CCH staff and to involve myself in the program.
I have read and received copies of the following:
Client Rights and Responsibilities Client Confidentiality at Catholic Charities Hawai`i Client Grievance Procedure
(check)
________ ________ ________
I understand that my consent to receive services, once given, may be withdrawn at any time (unless treatment is court ordered) by my stating that intention to any CCH staff member. I hereby willingly consent to full participation in the program of services offered to me by Catholic Charities Hawai`i.
___________________________
_________________________
_________
Print name (client/ parent/guardian)
Signature (client/ parent/guardian)
Date
___________________________
_________________________
_________
Print name (client/ parent/guardian)
Signature (client/ parent/guardian)
Date
___________________________
_________________________
_________
Print name (CCH staff witness/unit)
Signature (CCH staff witness/unit)
Date
