Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help

personal funds of a resident for any item(s) or services
for which payment is made under Medicaid or
Medicare (except for applicable deductible and
coinsurance amounts).
2. The facility may charge to resident’s funds, any
item(s) or services requested by a resident, if the
facility informs the resident there will be a charge and
if payment is not made by Medicaid or Medicare.
F-163 Free Choice/Physician. The resident has the right to
choose a personal attending physician regarding:
Care (refer to F-154)
Planning Care (refer to F-280).
F-164 Privacy and Confidentiality. The resident has the right
to personal privacy and confidentiality of his or her
personal and clinical records.
F-165 Voice Grievances. The resident has the right to voice
grievances without discrimination or reprisal. Such
grievances include those with respect to treatment
which has been furnished as well as that which has not
been furnished.
F-166 Resolution of Grievances. The resident has the right to
prompt efforts by the facility to resolve grievances the
resident may have, including those with respect to the
behavior of other residents.
F-167 Examination of Survey Results. The facility must make
the results of the most recent survey (Federal or State)
available for examination in a place readily accessible
to residents and must post a notice of their availability.
F-168 Agencies Acting as Advocates. The resident has the
right to receive information from agencies acting as
client advocates, and be afforded the opportunity to
contact these agencies.
F-169 Work. The resident has the right to refuse to perform
services for the facility.
F-170 Mail. The resident has the right to privacy in written
communications, including the right to send and
promptly receive mail that is unopened.
F-171 Access to Stationary. The resident has the right to have
access to stationery, postage, and writing implements at
the resident’s own expense.
F-172 Access & Visitation Rights. The facility must provide
reasonable access to any resident by an entity or
individual that provides health, social, legal, or other
services to the resident, subject to the resident’s right to
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