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100

To be treated with______, consideration, dignity, and full recognition of his or her individuality and right to privacy

Respect

100

To be free of exposure to mental and physical abuse, _______, and exploitation

Neglect

100

To receive a reasonable ________ to his or her requests from the Program Director or designee, managers and staff

Response

100

To receive a ____ of these rights upon admission to a Summit program.

Copy

200

To receive upon admission and during his or her stay a written _________ of the services provided by the facility and the charges for these services

Statement

200

To have and use his or her personal possessions where reasonable and have an accessible, ________ space provided for security of personal valuables.

Lockable

200

If authority to manage personal needs funds has been delegated to Summit Support Services, the resident has the right to examine the account at any time. To ensure that the consumer’s_____ are accurately accounted for and that each resident has and can spend his or her money, the following policy exists

Funds

200

To have access at any reasonable hour to a________ where he or she may speak privately.

Telephone

300

To be free from chemical and/or physical ________ unless authorized for a specific period of time by a physician according to clear and indicated medical need

Restraint 

300

To have his or her personal medical records kept ____________ and not disclosed if he or she objects in writing unless required by state or federal law or regulation. This is to include an automated data banking system

confidential

300

To send and receive mail promptly and _________, unless the consumer requests that someone open and read mail; and to have access to writing instruments, stationery, and postage at consumer’s expense

Unopened

300

To have the freedom to participate by choice in accessible community activities, and in social, political, medical and religious resources, and to have freedom to _____ such participation

Refuse

400

To receive care and services which are adequate, ___________ and in compliance with relevant federal and state laws, rules and regulations

Appropriate 

400

To associate and communicate privately and without restriction with people and groups of his or her own _____ on his or her own initiative. This includes visits in the family home as well the family visiting in the consumer’s home

Choice

400

To be provided a quiet atmosphere for uninterrupted sleep during customary sleeping hours and to be provided an area for personal ______ for at least limited periods of time, unless deemed inappropriate by the treatment or PCP team

Privacy 

400

To be a free agent without ___________ unless otherwise indicated

guardianship

500

To be encouraged to exercise his or her rights as a resident and citizen, and to be permitted to make complaints and suggestions without fear of coercion or __________, and to be able to express opinions on issues concerning his or care or treatment

Retaliation 

500

To be_______ if and when Summit Support Services is issued a provisional license by the North Carolina Department of Facility Services and the basis on which the provisional license was issued

Notified

500

To be free from ____________ in employment-related training or gainful employment and to be free from exploitation in performing productive work

exploitation

500

It is the policy of Summit Support Services that a consumer may be involved in ________  only with his or her written consent

Research 

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