As a client, you have the right to:

Be treated with dignity, compassion, and respect at all times.

Receive services without discrimination based on race, color, age, sex, religion, national origin, disability, or any other protected class.

Be fully informed about the services you will receive, including risks and benefits.

Participate actively in the creation and revision of your care plan.

Choose your caregivers and refuse service from any staff member.

Receive care in a safe, clean environment free from neglect and abuse.

Maintain your personal privacy and confidentiality of medical and personal information under HIPAA.

Voice complaints, concerns, or grievances without fear of retaliation.

Be informed of the cost of services and payment responsibilities in advance.

Request copies of your records and request corrections to inaccurate information.

Receive care that respects your cultural, spiritual, and personal preferences.

Be informed of and participate in any decisions about changes in services.

Have access to the Maryland Department of Health Complaint Hotline: 1-877-402-8218.

Appoint a representative to act on your behalf if you are unable to make decisions.

As a client, you are responsible for:

Treating staff with courtesy and respect.

Providing complete and accurate health and personal information.

Notifying the agency of any changes in your condition or emergency contact.

Following your agreed-upon care plan and service schedule.

Notifying the agency 24 hours in advance of cancellations or reschedules.

Ensuring a safe home environment for care to be provided (clear walkways, secure pets, etc.).

Informing staff of any advance directives or changes in legal guardianship.

Reporting concerns, dissatisfaction, or service changes promptly.

Securing personal valuables during service hours.

Complying with financial agreements for payment of services.

Cooperating in resolving any service delivery or scheduling issues.

Not engaging in harassment, intimidation, or inappropriate behavior toward staff.

Carrying out any mutually agreed-upon responsibilities outlined by the agency.

I acknowledge that I have read and understand my rights and responsibilities as a client of Ambition HomeCare LLC.

I consent to the collection, use, storage, and processing of my personal and, where applicable, health-related information, including any data I submit on behalf of others, for the purpose of evaluating or fulfilling my request made through this form. I understand this will be handled in accordance with the Privacy Notice.