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DEPARTMENT OF HEALTH & HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES OMB Approval No. 09381019AN IMPORTANT MESSAGE FROM MEDICARE ABOUT YOUR RIGHTS AS A HOSPITAL INPATIENT, YOU HAVE THE RIGHT

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How to fill out you have a right

01

Identify the rights that you have according to laws and regulations.

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Collect any necessary information or documentation to support your claim of having a right.

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Submit the filled-out forms or documentation to the relevant authority or organization within the specified deadline.

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Individuals who want to assert their legal rights and protections.

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Citizens who feel their rights are being infringed upon by government authorities or other entities.

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What is you have a right?

You have the right to exercise your legal rights and freedoms.

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Anyone who believes their rights have been violated or compromised.

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You can fill out a rights violation form and submit it to the relevant authorities.

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You must report the details of the rights violation, the individuals involved, and any evidence supporting your claim.

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