Rights and Responsibilities, SFN 1047 525-05-60-12

(NEW 5/1/19 ML #3551)

Purpose: All individuals receiving Home and Community Based Services (HCBS) must be made aware and provided a copy of his/her rights and responsibilities (DHS brochure number DN 46).

The HCBS Case Manager must inform all clients of his/her rights and responsibilities by providing and reviewing all rights and responsibilities:

Clients’ rights;
Clients’ and/or legal decision makers responsibilities;
HCBS Case Manager’s responsibilities; and
What to do if there is suspected fraud or abuse

After the client has reviewed, he/she or his/her legal representative must complete the following on the DN 46:

Client’s Name;
Client’s/Legal Representative’s Signature;
Case Manager’s Name;
Case Manager’s Phone Number; and
Date.

A copy is to be given to the client and/or his/her legal representative and a copy is filed in client’s case record.

The Rights and Responsibilities brochure (DN 46) may be found by visiting: https://www.nd.gov/dhs/info/pubs/aging.html.