Client Rights and Responsibilities Agreement

You have certain important rights guaranteed to you as a client of The Providence Center. We want you and/or your parents or guardians to know, understand, and exercise these rights, which are listed below:

EQUAL TREATMENT
To be treated without regard to my race, religion, gender, age, marital status, national origin, sexual preference, mental retardation, or mental or physical handicap. This includes access to translated materials and staff or translators that can assist me if English is not my first language.

To be provided treatment and services in an environment free of abuse, neglect, financial exploitation, and any other human rights violation.

To be protected from coercion.

CONFIDENTIALITY & PRIVACY
To understand how my Protected Health Information (PHI) is disclosed for purposes of treatment, payment and healthcare operations. (These types of disclosures are further defined in the Notice of Privacy Practices which is provided to you along with this document.)

To be treated with respect for my privacy. This includes the rights:
To have my medical record and source of payment for services remain confidential (except as otherwise noted in the Notice of Privacy Practices); and
To have the entire staff keep my identity, diagnosis, prognosis and treatment confidential.

To require my consent for the use of tape recordings, videotapes, and/or photographs of me and to be informed of their purpose and how they will be used.

The right to privacy, security, and confidentiality of your identity, diagnosis, prognosis, and treatment.

To provide or refuse authorization for participation in your treatment, or for the release of confidential information to family members or others.

To access your medical records in compliance with applicable state and federal laws.

To be given information regarding your pertinent legal rights relative to the Representative Payee Program, when applicable.

TREATMENT WITH DIGNITY
To be treated with respect for my personal dignity.

To receive safe and considerate treatment provided in the least restrictive environment.

To refuse to participate in any research study without losing treatment services.

To exercise my rights as a client of The Providence Center without fear of adverse consequences.

Not to be required to perform services for The Providence Center instead of paying treatment fees except when it is part of my treatment plan and I agree to it.

SERVICE BY QUALIFIED STAFF
To have qualified, competent staff supervise and provide services.

To be provided, upon request, information about the credentials, training, professional experience, and specialization of your providers and their supervisors.

INFORMATION ABOUT MY TREATMENT AND MEDICATIONS
To be informed of my rights, treatment and medication in a language I understand.

To have the opportunity to ask questions about my rights.

To be given the name, the professional qualifications, and the position of the staff member responsible for my care and their supervisor.

To be informed in advance if there is a proposed change in my primary therapist.

To be informed of what to expect when I receive treatment.

To be told about the risks, benefits and side effects of any medication or treatment prescribed.

To refuse treatment or medication (to the extent permitted by law), and to be informed of the likely results of my refusal.

To be informed in advance if I am to be transferred to a different treatment program and to be given an explanation for my transfer.

To receive a copy of the patient brochure, which contains program rules, services provided, clients' rights, and other important information.

To receive the following information during orientation and upon verbal or written request:

Accreditation status of The Providence Center;
Discharge policies;
Areas of treatment specializations at The Providence Center;
Hours of operation;
Emergency contact procedures
Procedures for resolving concerns and complaints

To be informed of your rights during orientation to The Providence Center, whenever The Center makes a change in the rights statement, and upon verbal or written request.

To be informed about, and to participate in, decisions regarding your treatment and services and to receive the information necessary for you to make informed decisions, including:

Your current diagnosis;
The limitations of confidentiality;
Projected discharge date and plan;
Ongoing review of your treatment goals, and mutually agreed upon adjustments of the treatment or service plan.

To object to any changes in treatment, services or personnel, and the right to a clear and written explanation if such an objection cannot be accommodated.

To be referred to an alternate service, program or treatment setting if you would be better served at a different level of care.

The right to screening for pain management, with a referral to your health care provider if appropriate.

PARTICIPATION IN MY TREATMENT PLAN
To participate in my treatment plan. This includes the right:

To participate in the development of my treatment plan.
To receive treatment based on my plan.
To request a change in the provider, clinician, or service, and if the request is denied, the right to receive a written explanation.
To be informed of the cost of services, the source of The Center's reimbursement, and any limitations placed on my treatment.
To have my treatment plan reviewed and updated periodically.
To be able to review my medical record with my primary therapist and/or to request a review of my treatment plan by another staff member (at no cost) or by an outside consultant (at my expense).
To be informed of relevant alternative treatment services available at The Providence Center.
To participate in planning my after-care activities, including referrals to other community services such as spiritual services that may help my recovery or improvement.
To provide feedback on The Providence Center program policies and services through satisfaction surveys.

COMPLAINTS
I, my family, legal guardian, or advocate have the right to initiate a complaint or grievance if I feel that an agency policy, procedure, or action has infringed upon my rights.

Concern and Complaints Procedure
In the event that I am dissatisfied with any aspect of my treatment or care, I have a right to initiate a complaint by contacting the staff person responsible for my care or by contacting the Human Rights Officer at the facility where I receive care. If I am uncomfortable making a complaint or need assistance doing so, I can ask a friend or family member to help or represent me. I will be offered a copy of the Concern and Complaint Resolution Procedure. The staff member providing assistance will make every attempt to resolve the concern.

When it cannot be resolved at this level, it will be considered a formal complaint, and I will be offered assistance in writing and submitting the complaint to the human rights officer and acquiring an advocate, if I prefer. The complaint will be logged by the human rights officer, and within four (4) business days of making a formal complaint, I will receive a written and verbal confirmation of the officer’s receipt of this complaint.

Within five (5) business days or less of the receipt of the complaint, the human rights officer will make an attempt at early resolution. If the problem is not resolved, the officer will investigate the circumstances surrounding the complaint, including speaking with people who may have other information or knowledge of the situation. The investigation will be completed within fifteen (15) days or less from the receipt of the complaint.

If the issue is resolved, a report noting the resolution will be forwarded to the designated department or staff person. If the issue is not resolved, I will be informed of my right to appeal. If I choose to appeal I will be reminded of my option to choose an advocate and will be offered assistance with this. I can also contact National Alliance for the Mentally Ill (401-331-3060), Mental Health Consumer Advocates (401-831-6937), or Rhode Island Communities for Addiction Recovery Efforts (401-521-5759), for assistance. If I feel that the matter is not resolved and my rights are not being protected, I have the right to contact the Office of the Mental Health Advocate (401-462-2003 or 1-800-346-2282), The Providence Center Consumer Advocacy Council (401-276-4104), The Human Rights Officer (401-276-4033) and/or the Office of the Child Advocate (222-6650) of the State of Rhode Island.

CLIENT RESPONSIBILITIES
My RESPONSIBILITIES as a client are:

To participate in treatment planning.
To come to sessions in an alcohol and drug-free condition.
To pay any fees that I have agreed to pay.
To respect the privacy of other clients of The Providence Center.
To attend all appointments or give adequate prior notice of cancellation.
To be familiar with my rights, responsibilities, and treatment.
To provide accurate information about myself that is relevant to my treatment.
To comply with the rules of the specific program to which I am assigned.
To treat other clients and staff respectfully.

I have read this list of my rights and responsibilities, and give my consent to treatment.

I understand that I may revoke this consent at any time, but The Providence Center may refuse further services at that time.

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