You and your family are a valued part of your healthcare team . We encourage you to talk with your team when you have questions or concerns .

A Spanish version of this information is available from your provider .

To Our Patients and Families :

At Children ’ s Hospital Colorado , you and your child are our main concern , and we will do everything we can to make your stay here as comfortable as possible . We are grateful for the trust you have in us , and we aim to give outstanding service to you / your child while you are here .

We know this is a stressful time for you . If you have a complaint , we give our word that we will try to resolve it as quickly as we can . We hope you will tell us when we do a good job and when we don ’ t .

Thank you for choosing Children ’ s Hospital Colorado and for letting us care for you / your loved one .

Sincerely , Jena

Hausmann President and Chief Executive Officer

Pat Givens , DHA , EdM , RN , NEA-BC Senior Vice President and Chief Nursing Officer

If you feel your rights have not been respected , please talk to your / your child ’ s healthcare team .

Individuals 18 years old and older have the right to make healthcare decisions .

You and / or your child have a right to : Communication

• A copy of the Patients ’ and Parents ’ Rights and Responsibilities . If you do not understand your rights , they will be explained to you in a language you understand .

• Understand your / your child ’ s care and treatment plan .

• Know the members of the healthcare team who are caring for and treating you / your child .

• Have a person and / or doctor of your choice be told about your / your child ’ s hospitalization .

• Get information about your / your child ’ s medical condition in words or a language you understand ( this requirement does not necessarily apply to medical record requests ). This information includes diagnosis , tests , procedures , and treatment options , as well as possible risks and benefits .

• Be a part of the decisions made about your / your child ’ s treatment . This includes asking for help from someone in the Ethics department , as well as naming a family spokesperson to work with the staff if ethical issues arise in your / your child ’ s care . Give informed consent for treatment and procedures . This includes changing your mind about treatment and procedures , refusing to sign a consent form if you do not understand and / or agree to everything , refusing treatment ( if the law allows ), and being told the risks of refusing treatment . If you do not consent to recommended treatment , you may need to seek care from another provider . If you decide to leave against medical advice , care providers are not obligated to follow-up with you , but you may return for future treatment or if you change your mind .

• Be told what you need to know and do when you or your child goes home .

• Have Children ’ s Hospital Colorado staff listen to what you say and answer your questions . Know that you can express your feelings or fears and get caring responses .

• Feel free to complain and get feedback without worrying that it will affect your / your child ’ s care . Please see the back panel for contact information .

• Get all medical care and treatment that is available and medically necessary regardless of your / your child ’ s race , color , national origin , ancestry , sex , creed , religion , cultural , economic , educational background , marital status , genetic information , gender identity or expression , sexual orientation , disability ( mental and physical ), or other protected classification to the extent required by applicable laws .

• Choose someone to make decisions if you / your child cannot make decisions .

• Sign an advance directive ( living will ) if allowed by law . Expect your / your child ’ s healthcare team to follow this directive , when it ’ s legal for them to do so .

• Decide not to take part in the training of healthcare workers , research , or in experimental programs .

• Get an estimated cost for services when you ask for it before we provide non-emergency care .

• Get information about Children ’ s Colorado ’ s financial assistance , charity care , and payment policies as provided by Colorado Revised Statute § 25-3-112 . Please see the back panel for contact information .

• An explanation of your bill and the services provided to you / your child .

Privacy and Dignity

• Get care and treatment that is right for you and your family ’ s emotional , educational , spiritual , and developmental needs . This means giving as much personal privacy as we can .

• Not be isolated or restrained in any way , as a means of control , punishment , convenience or revenge by the staff .

• Get comfort and respectful care if you are / your child is dying . This includes managing pain , respecting cultural and spiritual concerns and giving compassionate care during your time of grief .

• Get care and treatment in a safe setting , free from bullying and abuse .

• Be told about pain and ways to relieve the pain .

• Have family around to comfort and help take care of you / your child whenever they can .

• Parents , legal guardians and the patient ’ s spouse / partner can visit 24 / 7 . All other visitors , including siblings , may only visit during visiting hours . Visitation restrictions may be put into place , or changed when appropriate to limit the spread of contagious disease , or for safety purposes .

• Be told if there is any reason why you / your child cannot have visitors .

• Decide who can visit you / your child in the hospital . Not have visitors limited or denied because of their race , national origin , religion , sex , gender identity or expression , sexual orientation , or disability .

• Decide who will care for you / your child after you leave Children ’ s Colorado . Children ’ s Colorado staff will give you information about care providers or available services .

• Be told whether referrals are to providers in which Children ’ s Colorado has a financial interest .

• Be told of the patient ’ s rights before giving or stopping patient care whenever possible .

• Be given access to the medical record after discharge .

• All requests to see and / or receive copies of medical records should be made to the Health Information Management / Release of Information Department .

• Expect that medical information be only shared with those allowed to have it , such as your medical team ( doctors , nurses , and social workers ), insurance providers , or people you ask for your records be shared with .

• For a full description of who we can share your medical records with , please refer to the Notice of Privacy Practices .

• If you have questions or concerns about your medical information being seen or used inappropriately , please see the back panel for contact information .

You and / or your child have the responsibility to : Communication

• Tell your / your child ’ s doctor or Children ’ s Colorado staff right away if you need a language other than English so that you can understand and give informed consent for your / your child ’ s care and treatment .

• Give true and complete information about you / your child ’ s health . Tell us about any unexpected changes in you / your child ’ s condition .

• For parents / legally authorized representatives , when asked , give us proof that you have the right to consent to your child ’ s admission and medical / surgical treatment .

• Give Children ’ s Colorado accurate information about your / your child ’ s current insurance coverage and / or eligibility for state or federal programs , and pay bills in a timely manner .

• Give us a copy of your / your child ’ s current advance directive ( living will ), if there is one .

• Ask questions if you don ’ t understand information or instructions .

• Follow the treatment plan you and the caregivers agree on . Be aware of what will happen if you refuse treatment or don ’ t follow instructions and take responsibility for those actions . Work with members of the medical team to have a pain management plan .

• Keep your appointments and be on time . If you can ’ t keep your / your child ’ s appointment , call as soon as possible to schedule a new one .

• Tell your / your child ’ s doctor , nurse , or patient representative if you have concerns or aren ’ t happy with the care you are / your child is receiving .

• Act appropriately and be respectful when you try to settle disagreements .

• Be thoughtful of other patients and Children ’ s Colorado staff by limiting noise levels and numbers of visitors .

• Respect the privacy of other children and families getting care at Children ’ s Colorado .

• Keep cell phones on silent / vibrate mode when around patients or the healthcare team .

• Have no more than two family members stay overnight in patient rooms , as facilities and requirements allow .

• Pay the medical bills for which you are responsible .

Follow Safety Rules

• Learn and follow Children ’ s Colorado ’ s rules and Standards of Behavior .

• Help the staff make Children ’ s Colorado a safe place for everyone by telling us about safety concerns you have .

• Not use illegal drugs , marijuana , alcohol , tobacco , e-cigarettes , and / or carry guns or other weapons .

• Not take pictures , videos , or recordings of staff , equipment , or any non-family members .

• Follow the rules for visitors . Parents or another adult in the family must look after children younger than 18 who come to visit you / your child . Children must also follow the rules .

• Always keep your personal items with you . Children ’ s Colorado is not responsible for any items that may be lost or stolen when left in the patient ’ s room or elsewhere at Children ’ s Colorado facilities .

• Not allow anyone who is under the influence of any substance to visit you / your child .

• Dress appropriately .

• Not swear , make threats , or engage in behaviors that impact patient care .

• Not have sexual relations or view content of an inappropriately sexual nature , including pornography , while at Children ’ s Hospital Colorado .

• Know if you break the rules , security will be called and you may be taken off the property .

• Know if you break the rules :

• The security team may be called and you may be asked to leave the unit or the hospital .

• We may need to restrict your child ’ s visitors .

• For virtual visits and telephone calls , your care team may end the virtual visit or phone call .

Contact Information : Complaints Feel free to complain and get feedback without worrying that it will affect your / your child ’ s care . You can call a Patient Advocate : Denver-Metro : Southern Colorado : Phone : 720-777-1010 Phone : 719-305-1010

You can also file a complaint with : The Colorado Department of Public Health and Environment ( CDPHE )

4300 Cherry Creek Dr . South , Denver , CO 80246 | 303-692-2800

The ESRD Network # 15 for any complaints about dialysis or kidney disease 165 South Union Blvd ., Suite 466 , Lakewood , CO 80228 info @ nw15 . esrd . net | 303-831-8818 or 1-800-783-8818

You can contact Behavioral Health Administration 710 S . Ash St ., Denver , CO 80246 | 303-866-7400 Email : cdhs _ bha @ state . co . us

You may also call the Colorado Department of Regulatory Agencies 1560 Broadway , Suite 110 , Denver , CO 80202 303-894-7855 or toll free : 1-800-886-7675

If you feel your patient safety or care quality concerns have not been addressed you may call The Joint Commission at 1-800-994-6610 .

Privacy If you have questions or concerns about your medical information being seen or used inappropriately , you may call : Patient Advocates : Denver-Metro : Southern Colorado : Phone : 720-777-1010 Phone : 719-305-1010

Compliance Anonymous Hotline : 866-568-5420

Privacy Officer : 720-777-5834 , or you may send a letter to : Children ’ s Hospital Colorado Attn : Privacy Officer 13123 E . 16th Avenue , Box 450 Aurora , CO 80045

Billing Billing information is available on our website at childrenscolorado . org / about / your-bill , or you may call us at 720-777-6422 .

You have the right to ask to see an in-network health care provider at an in-network facility . If an in-network provider is not available , you may receive medical services from an out-of-network provider . For questions , please call your health insurance plan at the number on your health insurance ID card or the Colorado Division of Insurance .

© Children ’ s Hospital Colorado 2024 All rights reserved . Children ’ s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . • ATENCIÓN : si habla español , tiene a su disposición servicios gratuitos de asistencia lingüística . Llame al 1-720-777-1234 . • CHÚ Ý : Nếu bạn nói Tiếng Việt , có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn . Gọi số 1-720-777-1234 . CC-140033966A-2024-01

It is the policy of Children ’ s Hospital Colorado to respect the rights of people 18 years old and older and those authorized by federal and state laws to make healthcare decisions :

• Agree to or turn down medical or surgical treatment , including not having or stopping life-sustaining treatment or asking not to be resuscitated .

• Have the option to review and re-write advance directives ( living wills ).

• To present advance directives or ask for help with writing them .

The presence or lack of an advance directive ( living will ) has no effect on your access to care , treatment , and services .

Children ’ s Hospital Colorado respects the rights of every patient / parent and is devoted to providing equal access for everyone .

This includes the right to communication in a language that you can understand . To provide safe and effective communication , our policy says that only professional and qualified medical interpreters can be used . This means that patients , their family members , and friends may not be used as the main interpreters when talking about medical care .

Medical interpreters transfer information from one language to another . They must completely understand the topics they are talking about , so they can accurately transfer information from one language to another . They must be sensitive to the cultures of the language ( s ) in which they interpret as well as maintain confidentiality and neutrality .

• Medical Interpreter Office : either in-house or contracted medical interpreters can be scheduled through the Children ’ s Hospital Colorado Medical Interpreter Office . Phone and video interpreter systems are also available at all Children ’ s Hospital Colorado locations . If you need help or if you have unanswered questions , please call the Children ’ s Hospital Colorado Medical Interpreter Office . Denver-Metro : Southern Colorado : Phone : 720-777-9800 Phone : 719-305-6363

You may also ask to speak with the Charge Nurse or House Supervisor .

• Sign Language : Children ’ s Hospital Colorado provides sign language interpretation either by an in-person RID-certified interpreter or by video remote interpretation ( VRI ) services for our patients and parents / legally authorized representatives who are deaf or hard of hearing .

• If the patient / parents / legally authorized representative needs either a sign language interpreter or a spoken language interpreter , please tell the registration desk when you check in or when you are scheduling your appointment , so that the patient ’ s record will show this , and an interpreter can be scheduled ahead of time to be at the appointment .

• All of these services are provided free of charge on behalf of Children ’ s Hospital Colorado .

Information is subject to change . Please refer to your Patients ’ and Parents ’ Rights and

in other languages . If you need these services , contact the hospital main line at 720.777.1234 .

mail , fax , or email . If you need help filing a grievance , the Corporate Compliance Officer is available to help you .

7697 ( TDD ) Complaint forms are available at http :// www . hhs . gov / ocr / office / file / index . html . Children ’ s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . ATENCIÓN : si habla español , tiene a su disposición servicios gratuitos de asistencia lingüística . Llame al 1-720-777-1234 . CHÚ Ý : Nếu bạn nói Tiếng Việt , có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn . Gọi số 1-720-777-1234 . 주의 : 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 . 1-720-777-1234 번으로 전화해 주십시오 注意 : 如果您使用繁體中文 , 您可以免費獲得語言援助服務。請致電 1-720-777-1234 。 ВНИМАНИЕ : Если вы говорите на русском языке , то вам доступны бесплатные услуги перевода . Звоните 1-720-777-1234 . ማስታወሻ : የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች ፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል ፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-720-777-1234 ( መስማት ለተሳናቸው .

ملحوظة : إذا كنت تتحدث اذكر اللغة ، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان . اتصل برقم 1-1234-777-720 ( رقم . ACHTUNG : Wenn Sie Deutsch sprechen , stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung . Rufnummer : 1-720-777-1234 . ATTENTION : Si vous parlez français , des services d ’ aide linguistique vous sont proposés gratuitement . Appelez le 1-720-777-1234 . ध्याान दनु होोस :् �तपााइलेे ने पााले बोोल्नहोन्छ भन तपााइकोो निनम्त भाषाा सहोायता सवााहोरू नःशल्क रूपामाा उपालेब्ध छ । फोोन गनु होोसर्् �1-720-777-1234 । PAUNAWA : Kung nagsasalita ka ng Tagalog , maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad . Tumawag sa 1-720-777-1234 . 注意事項 : 日本語を話される場合、無料の言語支援をご利用いただけます。 1-720-777-1234 まで、お電話にてご連絡ください。 Ntị : Ọ bụrụ na asụ Ibo , asụsụ aka ọasụ n ’ efu , defu , aka . Call 1-720-777-1234 . GOVT-160148057-2023-12

VISUAL IDENTITY : DISCLAIMERS

Disclaimers

Section 1557 disclaimer

The section 1557 disclaimer is not required to be included on all materials . We only need to post it within the hospital and include it in primary hospital documentation ( not on the In Care of Kids documents or vaccine documents , nor in most marketing materials we create ).

What is considered primary hospital documentation ? Primary hospital documentation includes documents that are provided to every patient irrespective of the services they are seeking and are provided on their first visit . For example the notice of privacy practices isn ’ t provided at every visit but would be considered a primary document .

SECTION 1557 SHORT DISCLAIMER

Use on the bottom of single-page primary hospital documents . Update the copyright year to the current year , and update the project code , year and month . Typeset in Arial , 5pt , 5pt leading , Cool Gray 7 or white .

Example :

SECTION 1557 LONG DISCLAIMER

Use on the last page of multipage primary hospital documents . Copy and paste this text into your document , as it uses mulitple fonts for the various languages . Update the copyright year to the current year , and update the project code , year and month . Typeset in 5pt , 5pt leading , Cool Gray 7 or white .

Example :

Patients ’ and Parents ’ Rights and Responsibilities

Information for our Patients and Families

Section 1557 Short Disclaimer

2024 ADVOCACY PRIORITIES : MAKING A DIFFERENCE

childrenscolorado . org / Advocacy advocacy @ childrenscolorado . org facebook . com / childhealthchampions @ COChildChamps

Discrimination is Against the Law . Children ’ s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . Children ’ s Hospital Colorado does not exclude people or treat them differently because of race , color , national origin , age , disability , or sex . Children ’ s Hospital Colorado provides free aids and services to people with disabilities to communicate effectively with us , such as : Qualified sign language interpreters , written information in other formats ( large print , audio , accessible electronic formats , other formats ). Children ’ s Hospital Colorado provides free language services to people whose primary language is not English , such as : Qualified interpreters , information written

If you believe that Children ’ s Hospital Colorado has failed to provide these services or discriminated in another way on the basis of race , color , national origin , age , disability , or sex , you can file a grievance with : Corporate Compliance Officer , 13123 E 16th Avenue , B450 , Aurora , Colorado 80045 , Phone : 720.777.1234 , Fax : 720.777.7257 , corporatecompliance @ childrenscolorado . org . You can file a grievance in person or by You can also file a civil rights complaint with the U . S . Department of Health and Human Services , Office for Civil Rights , electronically through the Office for Civil Rights Complaint Portal , available at https :// ocrportal . hhs . gov / ocr / portal / lobby . jsf , or by mail or phone at : U . S . Department of Health and Human Services 200 Independence Avenue , SW Room 509F , HHH Building Washington , D . C . 20201 1-800-368-1019 , 800-537-

Section 1557 Long Disclaimer

© Children ’ s Hospital Colorado 2024 All rights reserved . Discrimination is Against the Law . Children ’ s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . Children ’ s Hospital Colorado does not exclude people or treat them differently because of race , color , national origin , age , disability , or sex . Children ’ s Hospital Colorado provides free aids and services to people with disabilities to communicate effectively with us , such as : Qualified sign language interpreters , written information in other formats ( large print , audio , accessible electronic formats , other formats ). Children ’ s Hospital Colorado provides free language services to people whose primary language is not English , such as : Qualified interpreters , information written in other languages . If you need these services , contact the hospital main line at 720-777-1234 . If you believe that Children ’ s Hospital Colorado has failed to provide these services or discriminated in another way on the basis of race , color , national origin , age , disability , or sex , you can file a grievance with : Corporate Compliance Officer , 13123 E 16th Avenue , B450 , Aurora , Colorado 80045 , Phone : 720-777-1234 , Fax : 720- 777-7257 , corporatecompliance @ childrenscolorado . org . You can file a grievance in person or by mail , fax , or email . If you need help filing a grievance , the Corporate Compliance Officer is available to help you . You can also file a civil rights complaint with the U . S . Department of Health and Human Services , Office for Civil Rights , electronically through the Office for Civil Rights Complaint Portal , available at https :// ocrportal . hhs . gov / ocr / portal / lobby . jsf , or by mail or phone at : U . S . Department of Health and Human Services 200 Independence Avenue , SW Room 509F , HHH Building Washington , D . C . 20201 1-800-368-1019 , 800-537-7697 ( TDD ) Complaint forms are available at http :// www . hhs . gov / ocr / office / file / index . html . Children ’ s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . ATENCIÓN : si habla español , tiene a su disposición servicios gratuitos de asistencia lingüística . Llame al 1-720-777-1234 . CHÚ Ý : Nếu bạn nói Tiếng Việt , có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn . Gọi số 1-720-777-1234 . 주의 : 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 . 1-720-777-1234 번으로 전화해 주십시오 注意 : 如果您使用繁體中文 , 您可以免費獲得語言援助服務。請致電 1-720-777-1234 。 ВНИМАНИЕ : Если вы говорите на русском языке , то вам доступны бесплатные услуги перевода . Звоните 1-720-777-1234 . ማስታወሻ : የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች ፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል ፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-720-777-1234 ( መስማት ለተሳናቸው .

ملحوظة : إذا كنت تتحدث اذكر اللغة ، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان . اتصل برقم 720-777-1234-1 ( رقم . ACHTUNG : Wenn Sie Deutsch sprechen , stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung . Rufnummer : 1-720-777-1234 . ATTENTION : Si vous parlez français , des services d ’ aide linguistique vous sont proposés gratuitement . Appelez le 1-720-777-1234 . ध्याान दनु होोस :् �तपााइलेे ने पााले बोोल्नहोन्छ भन तपााइकोो निनम्त भाषाा सहाायता सवााहोरू नःशल्क रूपामाा उपालेब्ध छ । फोोन गनु होोसर्् �1-720-777-1234 । PAUNAWA : Kung nagsasalita ka ng Tagalog , maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad . Tumawag sa 1-720-777-1234 . 注意事項 : 日本語を話される場合、無料の言語支援をご利用いただけます。 1-720-777-1234 まで、お電話にてご連絡ください。 Ntị : Ọ bụrụ na asụ Ibo , asụsụ aka ọasụ n ’ efu , defu , aka . Call 1-720-777-1234 . CODE-16000000-2024-08

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Internal - Children's Colorado Brand Guidelines Internal | Page 61

Disclaimers