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