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

(Revised 05/01/23 ML #3730)

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

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

• Client's rights;
• Client and/or legal decision maker's responsibilities;
• HCBS Case Manager’s responsibilities;
• What to do if there is suspected abuse, neglect, or exploitation; and
• What to do if there is suspected fraud or abuse

After the client has reviewed, the client's 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 the client's 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.hhs.nd.gov/sites/www/files/documents/DHS%20Legacy/brochure-hcbs-consumers-rights-responsibilities-dn-46.pdf