The State home must post a written statement of participant and family caregiver responsibilities in a place where participants in the adult day health care program and their families will see it and must provide a copy to the participant and caregiver at or before the time of the intake screening. The statement of responsibilities must include the following:

1. (a) Treat personnel with respect and courtesy;
2. (b) Communicate with staff to develop a relationship of trust;
3. (c) Make appropriate choices and seek appropriate care;
4. (d) Ask questions and confirm your understanding of instructions;
5. (e) Share opinions, concerns, and complaints with the program director;
6. (f) Communicate any changes in the participant's condition;
7. (g) Communicate to the program director about medications and remedies used by the participant;
8. (h) Let the program director know if the participant decides not to follow any instructions or treatment; and

9. (i) Communicate with the adult day health care staff if the participant is unable to attend adult day health care.

   (The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0160)