If you have any questions about these rights, please let me know.  As my client, you have a right to be treated with dignity and respect, to receive treatment services free of discrimination based on the your race, religion, ethnic origin, age, disabling or a medical condition, and ability to pay for the services.  You have a right to privacy in treatment, including the right not to be fingerprinted, photographed, or recorded without consent.  You have the right to receive assistance from a family member, designated representative, or other individual in understanding, protecting, or exercising the your rights.  You have a right to receive an individualized treatment plan that includes your participation in the development of the plan and a periodic review and revision of your treatment plan.  You have a right to refuse treatment or withdraw consent to treatment unless such treatment is ordered by a court or is necessary to save your life or physical health.  You have a right to receive a referral to another program if I am unable to provide a treatment service that you request or that is indicated in your assessment or treatment plan.  You have a right to have your information and records kept confidential and released according to HIPPA.  You have a right to be treated in the least restrictive environment consistent with your clinical condition and legal status.  You have a right to exercise the grievance procedures, to receive a response to a grievance in a timely and impartial manner, to be free from retaliation for submitting a grievance to me, the state of Kansas, Colorado, or another entity.  You have a right to receive your own information regarding medical and psychiatric conditions, prescribed medications including the risks, benefits, and side effects, whether medication compliance is a condition of treatment, and discharge plans for medications.  You have a right to obtain a copy of your clinical record at your own expense.  You have a right to be informed at the time of admission and before receiving treatment services, the fees you are required to pay, refund policies and procedures, and to receive treatment recommendations and referrals.