Rights of Individuals Form (IL462-1201)

Department of Human Services
Division of Developmental Disabilities
Information Bulletin

Rights of Individuals Form (IL462-1201)


Among the forms included in the appendices to the Waiver Manual is a form entitled Rights of Individuals. This form provides information to individuals served in Waiver programs regarding their rights. It also provides contact information for agencies that can assist individuals in ensuring their rights are protected.

Revised Form

The Division has revised this form to include the following:

  • A statement regarding the individual's right to choose and change providers.
  • The addition of "exploitation."
  • Instructions about filing complaints.

Use of the Revised Form

This form is to be provided to and discussed with individuals (or their guardians) by the Individual Service and Support Advocacy providers at the time of Waiver enrollment and at the time of each annual redetermination of eligibility. The form must be signed by the individual or guardian and placed in the individual's record. The form may also be used by direct service providers.

Effective Date

This version of the form may be used effective immediately with the release of this Information Bulletin; however, this version must be used beginning August 1, 2011. Earlier versions of the form, dated on or after August 1, 2011 will not be acceptable to regulatory compliance reviewers.