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 Haitian Creole. 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 receiving services from the Aging and Disability Services Administration and Developmental Disabilities Administration in Washington.
Q: What does the document cover?
A: The document covers the rights and responsibilities you have when receiving services from the Aging and Disability Services Administration and Developmental Disabilities Administration.
Q: Who does this document apply to?
A: This document applies to individuals who receive services from the Aging and Disability Services Administration and Developmental Disabilities Administration in Washington.
Q: What are some of the rights outlined in this document?
A: Some of the rights outlined in this document include the right to be treated with respect and dignity, the right to have your privacy protected, and the right to access necessary services and supports.
Q: What are some of the responsibilities outlined in this document?
A: Some of the responsibilities outlined in this document include providing accurate information, actively participating in your care, and treating staff and other individuals with respect.
Q: What should I do if I have a concern or complaint?
A: If you have a concern or complaint, you should contact the appropriate agency or program to address the issue.
Q: Is this document available in Haitian Creole?
A: Yes, this document is available in Haitian Creole.
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.