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