Your Rights as a Consumer

Of Jireh Counseling and Consulting Services

Mental Health, Developmental Disabilities, and Addictive Diseases

State and Federal laws protect your rights as a consumer of Jireh Counseling and Consulting Services treatment
programs. Below is a simplified outline of those rights:

Your rights include:

• The right to receive care suited to your needs.

• The right to receive services that respect your dignity and protect you health.

• The right to pertinent information, including the benefits and risks of your treatment, in sufficient time
to make informed decisions.

• The right to participate in planning your own program, and the right to request choice over the
composition of the service delivery team.

• The right to refuse service, unless a physician or licensed psychologist feels that refusal would be
unsafe for you and others.

• The right of referral to legal entities for appropriate representation, and to self-help and advocacy
support services.

• The right to prompt and confidential services even if you are unable to pay.

• The right to request an opportunity to inspect, copy, and correct your records).

• The right to exercise all civil, political, personal, privacy and property rights to which you are entitled
to as a citizen.

• The right to remain free of physical restraints or time-out procedures unless such measures are
required for providing effective treatment or for protecting your safety or the safety of others.

• The right to be free of physical abuse, including sexual abuse, and physical punishment.

• The right to remain free of psychological abuse, including humiliating, threatening, and exploiting
actions.

• The right to file a complaint if you think any of these rights have been restricted or denied.
Information on how to file a complaint or contact your Consumer's Rights Representatives is
presented on a poster near the reception desk.

CR100—Consumer Rights RevOct 08

 Consumer Rights and Responsibilities

Consumer Receipt & Acknowledgement of Rights:

My signature below certifies that I have read AND understand completely what my rights are as a participant in
Jireh Counseling And Consulting Services, Inc. program.

___________________________ ______________
Consumer Signature Date

___________________________
Consumer Name (Print)

____________________________ _____________
Staff Witness Date

CR100—Consumer Rights RevOct 08