Name *

First Name

Last Name

At which site are you located? *

Isabella House

Sun Ray Court

Outpatient - Main

Outpatient - Valley

PCAP

Admin

Did you complete the Patient Rights, Responsibilities & Advance Directives Training Program? *

Yes

No

Did you understand the material presented? *

Yes

No

True or False: Consent must be: Voluntary, Competent, and Informed. *

True

False

True of False: Patients have the right to receive considerate and respectful care provided in a safe environment, free from all forms of abuse, harassment or discrimination. *

True

False

True or False: In an emergency situation, a Patient has a right to treatment, regardless of ability to pay. *

True

False

Should I have any questions regarding Patient Rights and/or Advanced Directives, I understand that am welcome to contact my supervisor, administrator, or the compliance officer. *

Yes

No