Boulder Medical Center Patient Bill of Rights

All Boulder Medical Center patients shall be given impartial treatment regardless of race, color, religion, age, gender, national origin, sexual orientation, disability, or source of payment. As a Boulder Medical Center patient, you have the rights listed below. Please read them carefully and ask questions if there is something you do not understand. If you do not speak the predominant language of the community, Boulder Medical Center will attempt to obtain an interpreter for you.

You have the right to:

•Be treated with respect, consideration, privacy and dignity.
•You have the right to participate in decisions regarding your health care.
•Know the identity and professional status of any individual providing service to you and to know which physicians or other practitioner is primarily responsible for your care.
•You have the right to privacy regarding your health information.
•Receive a written copy of a Privacy Notice upon request which provides explanation of how your protected health information is utilized and to those that may need to receive it.
•You have a right to know what Center rules and regulations apply to your conduct as a patient.
•Give an informed consent to the physician prior to the start of a procedure.
•Good Quality care and high professional standards that are continually maintained.
•Receive care in a safe setting and one free of all forms of abuse or harassment.
•You have the right to refuse any drug, test, procedure or treatment.
•Health services consistent with current professional knowledge.
•Receive an explanation of your procedure billing.
•Expect emergency procedures to be implemented without delay.
•Be informed verbally and in writing that this Center does not honor Do NotResuscitate requests.
•Expect expedient and professional transfer to another facility when medically necessary and notify the receiving facility prior to transfer. The receiving facility may not honor the request to withhold Cardio Pulmonary Resuscitation.
•Have personal belongings safeguarded and returned upon discharge.
•Receive a verbal and written notice of these patient rights & responsibilities, information pertaining to this facility’s policy on advance directives (and any stateforms upon request) and written disclosure of physician ownership in this facilityall of which will be provided in advance of your date of service. The BoulderMedical Center, P.C. is a professional corporation which employs all of the physicians and employees who work at the Medical Center. Physicians at BMC areowners.
•Full information in layman’s terms regarding diagnosis, treatment and preventive measure; if it is medically advisable to present this information. If not the information shall be provided to the designated responsible representative on your behalf.

Patient Responsibilities - You have the responsibility to:

•Provide full cooperation with regards to instructions given by your physician.
•Provide the Center with all medical information, which may have a direct effect on your care.
•Follow instructions and treatment plan.
•Be respectful and considerate of other patients, guests and Center staff.
•Provide a responsible adult to transport you home from this facility and remain with you for 24 hours if required by your physician.
•Inform facility staff about any advance directives (such as living will or medicalpower of attorney) that could affect your care.
•Provide the Center with all information regarding third-party insurance coverage.
•Fulfill financial responsibility for all services received, as determined by you rinsurance carrier.
•Inform a staff member of any of the following: If you feel that your privacy has been violated; if you feel your safety is being threatened; if you feel a need/desire to file a grievance.

File a Concern, Suggestion or Grievance:                                             A patient may expect to exercise his or her rights without being subjected to discrimination or reprisal.

•With any staff member
•Patient Advocate Boulder Medical Center, P.C. & Disability Section 504 Coordinator

2750 Broadway Boulder CO 80304                                                  Phone (303-440-3125 FAX (303-440-3282 e-mail
   PatientConcerns@bouldermedicalcenter.com

•Colorado Department of Public Health & Environment
Health Facilities & Emergency Medical Services Division

Attn: Complaint Intake                                                                       4300 Cherry Creek Dr. So; Denver, CO 80246-1530

E-mail - hfdintake@cdphe.state.co.us                                              Phone (303) 692-2904 Fax (303)753-6214

•Medicare Beneficiary Ombudsman-Contact for information and understanding o fbeneficiary rights and protections
http://www.medicare.gov/navigation/help-and-support/ombudsman.aspx

Call 1-800-633-4227 to get help. TTY users should call 1-877-486-2048.

A patient may exercise his or her rights without being subjected to discrimination or reprisal.

Section 504 Notice of Program Accessibility

Boulder Medical Center, P.C. and all of its programs and activities are accessible to and useable by disabled persons, including persons who are deaf, hard of hearing or blind, or who have other sensory impairments. Access features include:

Convenient off-street parking designated specifically for disabled perosns.
Curb cuts and ramps beparking areas and buildings.
Level access into first floor level with elevator access to all other floors.
Fully accessible offices, bathrooms, public waiting areas, patient treatment areas, including examining rooms.
Qualified sign language interpreters for persons who are deaf or hard of hearing.

If you require any assistance, please let the receptionist or your nurse know.

To file a Section 504 Grievance:

Boulder Medical Center, P.C.

Section 504 Coordinator

Phone (303) 440-3125 FAX (303)440- 3282

E-Mail PatientConcerns@bouldermedicalcenter.com

U.S. Department of Health & Human Services

Regional Office for Civil Rights

999 18th Street, Room 417

Denver, CO 80202

Phone (303)844-7915 FAX (303) 844-2025 TDD (303) 844-3439