51 Choice of Physician 6 Information About Rights 72 Confidentiality About Your Condition 21 Dental Services 9 Manage Own Finances 69 Prompt Efforts by Facility to Resolve Grievances 28 Food Substitutes 74 Name of and How to Contact Physician 38 Have Personal Possessions 56 Privacy in Treatment 25 Raise Concerns 31 Withdraw Consent for Visitors 53 Unopened Mail 5 Notice Before Discharge 14 Participate in Community Activities 50 Only Certain reason for Transfer 37 Good Social Services 12 Choice of Routine 8 Discharge Planning 42 Telephone Privacy 4 Have Visitors 71 Freedom of Discrimination 27 Sufficient Staff 33 Security for personal Belongings 15 Freedom from Physical Restraints 22 Trained Nurses Aids 35 Refuse Medication or treatment 18 Special Diets 26 Examine Survey Results 20 Consideration 73 Written Notice of Right to Appeal 75 Protection of Funds 52 Appropriate Exercise 3 Private Closet Space 29 Participate in Care Planning 59 Receive Proper Assistive Devices 2 Safe Environment 1 Adequate Lighting 17 Comfortable Temperature Levels 55 Freedom from Verbal Abuse 61 Comfortable Sound Levels 66 Privacy 64 Sexuality 67 Communications with Persons of Your Choice 44 Licensed Facility 24 Examine Records 40 Clean Bed Linens 46 Life Safety 54 Participate in Activities of Choice 16 Private Communication 13 Appropriate Health Care 70 Vote 32 Freedom from Physical Abuse 48 Married Couple Sharing a Room 49 Nutritional Meals 60 Freedom of Reprisal 45 Dignity 62 Religious Freedom 41 Information abouy Ombudsman 51 Choice of Physician 6 Information About Rights 72 Confidentiality About Your Condition 21 Dental Services 9 Manage Own Finances 69 Prompt Efforts by Facility to Resolve Grievances 28 Food Substitutes 74 Name of and How to Contact Physician 38 Have Personal Possessions 56 Privacy in Treatment 25 Raise Concerns 31 Withdraw Consent for Visitors 53 Unopened Mail 5 Notice Before Discharge 14 Participate in Community Activities 50 Only Certain reason for Transfer 37 Good Social Services 12 Choice of Routine 8 Discharge Planning 42 Telephone Privacy 4 Have Visitors 71 Freedom of Discrimination 27 Sufficient Staff 33 Security for personal Belongings 15 Freedom from Physical Restraints 22 Trained Nurses Aids 35 Refuse Medication or treatment 18 Special Diets 26 Examine Survey Results 20 Consideration 73 Written Notice of Right to Appeal 75 Protection of Funds 52 Appropriate Exercise 3 Private Closet Space 29 Participate in Care Planning 59 Receive Proper Assistive Devices 2 Safe Environment 1 Adequate Lighting 17 Comfortable Temperature Levels 55 Freedom from Verbal Abuse 61 Comfortable Sound Levels 66 Privacy 64 Sexuality 67 Communications with Persons of Your Choice 44 Licensed Facility 24 Examine Records 40 Clean Bed Linens 46 Life Safety 54 Participate in Activities of Choice 16 Private Communication 13 Appropriate Health Care 70 Vote 32 Freedom from Physical Abuse 48 Married Couple Sharing a Room 49 Nutritional Meals 60 Freedom of Reprisal 45 Dignity 62 Religious Freedom 41 Information abouy Ombudsman
(Print)
51
Choice of Physician
6
Information About Rights
72
Confidentiality About Your Condition
21
Dental Services
9
Manage Own Finances
69
Prompt Efforts by Facility to Resolve Grievances
28
Food Substitutes
74
Name of and How to Contact Physician
38
Have Personal Possessions
56
Privacy in Treatment
25
Raise Concerns
31
Withdraw Consent for Visitors
53
Unopened Mail
5
Notice Before Discharge
14
Participate in Community Activities
50
Only Certain reason for Transfer
37
Good Social Services
12
Choice of Routine
8
Discharge Planning
42
Telephone
Privacy
4
Have Visitors
71
Freedom of Discrimination
27
Sufficient Staff
33
Security for personal Belongings
15
Freedom from Physical Restraints
22
Trained Nurses Aids
35
Refuse Medication or treatment
18
Special Diets
26
Examine
Survey Results
20 Consideration
73
Written Notice of Right to Appeal
75
Protection of Funds
52
Appropriate Exercise
3
Private Closet Space
29
Participate in Care Planning
59
Receive Proper Assistive Devices
2
Safe Environment
1
Adequate Lighting
17 Comfortable Temperature Levels
55
Freedom from Verbal Abuse
61
Comfortable Sound Levels
66
Privacy
64
Sexuality
67
Communications with Persons of Your Choice
44
Licensed Facility
24
Examine Records
40
Clean Bed Linens
46
Life Safety
54
Participate in Activities of Choice
16
Private Communication
13
Appropriate Health Care
70
Vote
32
Freedom from Physical Abuse
48
Married Couple Sharing a Room
49
Nutritional Meals
60
Freedom of Reprisal
45
Dignity
62
Religious Freedom
41
Information abouy Ombudsman
