Forms & Posters

Commonly used forms and posters relating to Patients' Rights in alphabetical order.

Advance Health Care Directives

  1. Advance Health Care Directives - English (PDF)
  2. Advance Health Care Directives - Large Print - English (PDF)
  3. Advance Health Care Directives - Large Print - Spanish (PDF)
  4. Advance Health Care Directives - Spanish (PDF)
  5. Advanced Health Care Directives - Audio Recording - English (MP3)
  6. Advanced Health Care Directives - Audio Recording - Spanish (MP3)

Beneficiary Protections Poster

  1. Beneficiary Protections Poster - English (PDF)
  2. Beneficiary Protections Poster - Spanish (PDF)

Change of Provider - Second Opinion

  1. Change of Provider - Second Opinion - English (PDF)

Conservatorship & You

  1. Conservatorship and You - English (PDF)
  2. Conservatorship and You - Large Print - English (PDF)
  3. Conservatorship and You - Large Print - Spanish (PDF)
  4. Conservatorship and You - Spanish (PDF)

Determining Language Preference

  1. Determining Language Preference - All Languages (PDF)

Grievance and Complaint Form

  1. Grievance and Complaint Form English (PDF)
  2. Grievance and Complaint Form Hmong (PDF)
  3. Grievance and Complaint Form Large Print (English) (PDF)
  4. Grievance and Complaint Form Large Print (Spanish) (PDF)
  5. Grievance and Complaint Form Spanish (PDF)

Grievance and Complaint Process

  1. Grievance and Complaint Process Audio Recording (English) (MP3)
  2. Grievance and Complaint Process Audio Recording (Spanish) (MP3)
  3. Grievance and Complaint Process English (PDF)
  4. Grievance and Complaint Process Hmong (PDF)
  5. Grievance and Complaint Process Spanish (PDF)

Language Access

  1. Language Access English (PDF)
  2. Language Access Large Print (English) (PDF)
  3. Language Access Large Print (Spanish) (PDF)
  4. Language Access Spanish (PDF)

Patients’ Rights Advocate Poster

  1. Patients Rights Advocate Poster English (PDF)
  2. Patients Rights Advocate Poster Hmong (PDF)
  3. Patients Rights Advocate Poster Spanish (PDF)

Patients' Rights Orientation Brochure

  1. Patients Rights Orientation Brochure Audio Recording (English) (MP3)
  2. Patients Rights Orientation Brochure Audio Recording (Spanish) (MP3)
  3. Patients Rights Orientation Brochure English (PDF)
  4. Patients Rights Orientation Brochure Large Print (English) (PDF)
  5. Patients Rights Orientation Brochure Large Print (Spanish) (PDF)
  6. Patients Rights Orientation Brochure Spanish (PDF)

TTY Phone Directions

  1. TTY Phone Directions Complete English (PDF)
  2. TTY Phone Directions English (PDF)

More forms and posters can be found on the Informing Materials page.

Contact

Patient Right’s Advocate
1196 East Lassen Avenue
Suite 130
Chico, CA 95973
Phone: 530-343-1731
Phone: 800-497-1445
Se habla Español

For grievances related to Substance Use Disorder Services:

Ombudsman Information

Butte County has contracted with Passages for all Ombudsman services. You can contact them and find more information on their website.