Revised: Rights of Individuals Form

Illinois Department of Human Services
Division of Developmental Disabilities
Information Bulletin

Revised:  Rights of Individuals Form
August, 2016


The purpose of this Informational Bulletin is to notify Division of Developmental Disabilities stakeholders throughout the service delivery system that a new version of the Rights of Individuals Form given to Medicaid Waiver Participants by the Independent Service Coordination Agencies is now available.


The Rights of Individuals Form (IL462-1201, R-06-16) has been updated to reflect current policies and procedures and is now available on the Department of Human Services web site.

Process and Procedures

The Rights of Individuals Form is shared and discussed with Medicaid Waiver Participants and their guardians at the time of enrollment in the Waiver and annually thereafter. The Division has updated the form to reflect current practices. Changes included in the modified form are:

  • Revised instructions about reporting allegations of abuse, neglect, and exploitation. These revisions bring this form into accord with current practice and statutes.
  • Updates of contact information for the Office of the State Guardian.
  • Clarification that exploitation is among the allegations that may be reported.
  • Information provided to locate appropriate agency.
  • Included form number in the Exercising Your Rights section.
  • Updated contact information for adults age 18 and over who reside in their home or family's home to call the Adult Protective Services Hotline.
  • Added contact information for individuals residing in a Community Living Facility (CLF) to contact the Department of Public Health.
  • The Division will require evidence of the use of this latest version of the form by the Independent Service Coordination agencies during its quality assurance reviews beginning with those conducted in FY17.
  • In the event direct service providers use this form or its content in their materials for individuals they serve, such providers should update their materials as quickly as possible.

Effective Date

The modified form is effective immediately upon release of this Information Bulletin.