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 Tagalog. 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 form that outlines your rights and responsibilities when you receive services from 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 services and support to older adults, people with disabilities, and their families in Washington state.
Q: What does Developmental Disabilities Administration (DDA) do?
A: DDA provides services and support to individuals with intellectual and developmental disabilities in Washington state.
Q: What are my rights when receiving services from ALTSA and DDA?
A: Your rights include the right to be treated with respect, the right to privacy, the right to make choices about your services, and the right to appeal decisions made about your services.
Q: What are my responsibilities when receiving services?
A: Your responsibilities include providing accurate information about your situation, participating in the development of your service plan, and notifying ALTSA or DDA of any changes in your circumstances.
Q: What should I do if I have a concern or complaint?
A: You should first try to resolve the issue with your service provider. If the issue remains unresolved, you can contact ALTSA or DDA to file a complaint or request a review of your case.
Q: Can I request an interpreter or translation services?
A: Yes, you have the right to receive services in your preferred language. You can request an interpreter or translation services at no cost to you.
Q: What happens if I disagree with a decision about my services?
A: You have the right to appeal any decision made about your services. You can request a hearing to present your case and have the decision reviewed.
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.