Form Dhcs 5080 - California C-9 Personal Rights Substance Use Disorder Treatment Facilities - Health And Human Services Agency
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1State of California — Health and Human Services Agency
Department of Health Care Services
Licensing and Certification Branch, MS 2600
PO Box 997413
Sacramento, CA 95899-7413
C-9 – PERSONAL RIGHTS – SUBSTANCE USE DISORDER TREATMENT FACILITIES
In accordance with Title 9, Chapter 4, Section 10569, of the California Code of Regulations, each person
receiving services from a residential alcoholism or drug abuse recovery or treatment facility shall have
rights which include, but are not limited to, the following:
The right to confidentiality as provided for in Title 42, Section 2.1 through 2.67-1, Code of
Federal Regulations.
To be accorded dignity in personal relationships with staff and other individuals.
To be accorded safe, healthful, and comfortable accommodations to meet his or her needs.
To be free from intellectual, emotional and/or physical abuse.
To be informed by the licensee of the provisions of law regarding complaints including, but
not limited to, the address and telephone number of the Department of Health Care Services.
To be free to attend religious services or activities of his or her choice and to have visits from
a spiritual advisor provided that these services or activities do not conflict with facility
program requirements. Participation in religious services will be voluntary only.
COMPLAINTS
In accordance with Title 9, Chapter 4, Section 10541(a), of the California Code of Regulations, any
individual may request an inspection of an alcoholism or drug abuse recovery or treatment facility.
Complaints should be directed to:
Department of Health Care Services
Licensing and Certification Branch, MS 2600
PO Box 997413 MS 2600
Sacramento, CA 95899-7413
Attention: Complaint Coordinator
(877) 685-8333
FAX (916) 322-2658
TDD: (916) 445-1942
Acknowledgement
I have been personally advised and have received a copy of my personal rights and have been informed of
the provisions for complaints at the time of my admission to:
(Name of Facility)
(Residents Signature)
DHCS 5080 (07/13)
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