CFS 496
10/2005 State of Illinois
Department of Children and Family Services
Client Rights and Responsibilities
Clients have the right to:
• Receive quality services in a respectful manner without discrimination;
• Make an informed choice of services;
• Know the qualifications of staff who provide them with services;
• Receive and understand information and instructions about their service needs;
• Consent to or refuse services before they are provided;
• Know the nature and purpose of services;
• Refuse services with the receipt of information and the consequences of refusal;
• Be informed prior to any transfer or discharge from services;
• Expect confidentiality of information and protection of their child welfare records;
• Receive timely response to their needs along with reasonable continuity and coordination of
services;
• Know about charges for services;
• Know how to voice any grievance about their services;
• Receive services based on an individual service plan;
• Be part of the process of updating the service plan when his or her needs change; and
• Receive all services at DCFS or be referred to another agency.
Clients have the responsibility to:
• Give accurate information about their mental health, substance use, and domestic violence
issues as well as other circumstances which might impact upon the care of their children;
• Assist by making and keeping a safe environment;
• Notify the agency if scheduled appointments need to be changed;
• Notify the agency if there is a change in your living arrangements;
• Work with staff in planning, reviewing and changing their individual service plans; and
• Inform staff immediately if they have any concerns or problems with the service they are
receiving.
Yes No I understand my rights and responsibilities.
Yes No I have been informed that my individual service plan will be developed.
Yes No I have received a copy of the Service Appeal Process brochure.
Yes No The information contained in the brochure has been explained to me.
Client Sign (12 years or older) or Client Name & Age Date