This version of the form is not currently in use and is provided for reference only. Download this version of DSHS Forme 16-172 for the current year.
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington.
The document is provided in French. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is DSHS Form 16-172?
A: DSHS Form 16-172 is a document that outlines your rights and responsibilities when you receive services offered by the Aging and Long-Term Support Administration and Developmental Disabilities Administration in Washington.
Q: What does Aging and Long-Term Support Administration do?
A: The Aging and Long-Term Support Administration provides services and supports to help older adults and individuals with disabilities live as independently as possible in their communities.
Q: What does Developmental Disabilities Administration do?
A: The Developmental Disabilities Administration provides services and supports to individuals with intellectual and developmental disabilities to help them live full and inclusive lives.
Q: Why is this document important?
A: This document is important because it informs you about your rights and responsibilities when accessing services from these government agencies.
Q: What are some examples of services offered by these agencies?
A: Services offered may include home care, respite care, case management, employment support, and residential support, among others.
Q: What are my rights when receiving services?
A: Your rights include being treated with dignity and respect, participating in decisions about your care, and having access to your records, among others.
Q: What are my responsibilities when receiving services?
A: Your responsibilities include providing accurate information, following the agreed-upon care plan, and treating staff and other clients with respect, among others.
Q: What should I do if I have concerns or complaints about the services?
A: If you have concerns or complaints, it is important to talk to your case manager or service provider to try and resolve the issue. If that doesn't work, you can contact the appropriate agency's grievance process.
Q: Can I appeal a decision made by the agencies regarding my services?
A: Yes, you have the right to appeal any decision made by the Aging and Long-Term Support Administration or Developmental Disabilities Administration regarding your services. The document provides information on how to initiate an appeal.
Form Details:
Download a printable version of DSHS Forme 16-172 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.