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