Agree Disagree Sample Clauses

Agree Disagree. Use of full name: ..............

Agree Disagree. I acknowledge that any breach of this agreement may result in the removal of my information for the NDSLIC distribution lists. Agree Disagree

Agree Disagree. INDIVIDUAL RIGHTS AND RESPONSIBILITIES I have received a written copy of the RHC Client / Resident Rights and Responsibilities (attached). I understand if I have any questions or concerns I can contact an RHC Supervisor, the Habilitation Plan Administrator, the Case Manager Resource Nurse, or the Patient Care Coordinator. INITIAL PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT (POLST) Does the resident have a POLST / advance directive? If interested in obtaining a POLST or to get more information on advance directives, contact the resident’s medical provider. Yes INITIAL No ADVOCACY INFORMATION If you have concerns about abuse or neglect reporting, or have concerns related to resident’s rights, there are advocacy agencies not affiliated with the RHC you can contact for assistance. These include: Disability Rights Washington, DD Ombudsman, Nursing Home Ombudsman program, or Complaint Resolution Unit (CRU) Hotline. CRU Number: ▇-▇▇▇-▇▇▇-▇▇▇▇ To file a grievance, see the attached Grievance Policy. INITIAL SIGNATURE DATE RELATIONSHIP Parent Guardian Relative (relationship): Superintendent / Custodial Guardian Disclaimer: Services at this RHC are based on the resident’s assessed needs and if you request services outside the interdisciplinary team determination, you are responsible for payment, transportation, and setup for that service. If you feel the resident needs a service not provided by the facility, contact the Habilitation Plan Administrator, Case Manager Resource Nurse, or Patient Care Coordinator so they can facilitate a team meeting to discuss the recommendation.

Agree Disagree. Applicant) hereby further acknowledge that I understand my ten (10) working days right of cancellation during the ten (10) working days cooling off period from the moment the agreement has been TERMINATED by default as stated in Clause 12 and

Agree Disagree. Use of artwork:....................

Agree Disagree. The Newcomer Family never fully opened up to me.

Agree Disagree. The Producer is not a party to any claims, disputes, or lawsuits Agree Disagree

Agree Disagree. For your added security, the front and back doors have a 4-digit code exclusive to your group’s stay. Only management and guests will have access during your time with us. The code will be provided to you at the time of check-in.

Agree Disagree. If disagreement, what is disposition of purported out-of-class work?