I understand that agency staff will supervise all services. I have received a copy and an explanation of the Bill of Rights.
I understand that it is my right and responsibility to be involved in my care and that I will be informed as to the nature and purpose of any technical procedure.
I understand the frequency of services. This frequency may change according to need.
I have been notified of my right to voice a complaint and may direct a complaint to the Administrator or designee at (855) 268-4098. An investigation of the complaint will be initiated within 3 calendar days and resolved within 10 calendar days of receipt.
I may also contact the Texas Health and Human Services (HHS) Consumer Rights and Services (CRS), at 1 (800) 458-9858. The line is open 24 hours a day. This includes a complaint regarding advance directives.
Complaints regarding Utilization Review or HMO services can be made directly to Texas Department of Insurance Consumer Protection , PO Box 149091, Austin, TX 78714, at 1 (800) 252-3439.
HIPAA - I have received the Notice of Privacy Practices and consent to the agency's use and/or disclosure of protected health information for
payment, treatment and Agency's health care operations.
I have been informed verbally and in writing regarding Agency policy on abuse, neglect and exploitation, agency drug testing and hazardous waste disposal in the home.
I have been informed what to do in an emergency/natural disaster and have received education on completing an emergency preparedness plan for myself and my family. I understand the importance of completing this plan and know that agency staff may assist in this process.