This version of the form is not currently in use and is provided for reference only. Download this version of DSHS Form 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 Turkish. 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 about the rights and responsibilities when receiving services offered by Aging and Long-Term Support Administration and Developmental Disabilities Administration in Washington.
Q: What does Aging and Long-Term Support Administration (ALTSA) do?
A: ALTSA provides support and services to older adults and people with disabilities.
Q: What does Developmental Disabilities Administration (DDA) do?
A: DDA offers services and support to individuals with developmental disabilities.
Q: What are my rights when receiving services from ALTSA or DDA?
A: You have the right to be treated with dignity and respect, have your privacy protected, and have access to information and participation in decisions about your care.
Q: What are my responsibilities when receiving services from ALTSA or DDA?
A: Your responsibilities include providing accurate information, cooperating with the staff, and following the rules and policies of the program.
Q: What should I do if I have a concern or complaint?
A: You should first try to resolve the concern with the staff. If that doesn't work, you can contact the program administrator or file a complaint with the state agency overseeing the program.
Q: What happens if I disagree with a decision made by the program?
A: You have the right to appeal the decision and request a fair hearing.
Q: Can I request an interpreter or translation services?
A: Yes, you have the right to request interpreter or translation services if needed.
Q: How can I access my records?
A: You have the right to access your records and receive copies, with some exceptions.
Q: Are there any costs associated with receiving services?
A: There may be costs depending on the program and your income, but you should be informed about any fees or charges before receiving services.
Form Details:
Download a printable version of DSHS Form 16-172 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.