469 W State Hwy 7
Suite 2
Broomfield, CO 80023
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Patient Rights and Responsibilities


Decision Making

You or your representative(s) have the right to:

  • Be informed before care is given or discontinued whenever possible.
  • Receive complete and current information regarding your health status in terms you can understand.
  • Participate in planning for your treatment, care and discharge recommendations.
  • Receive an explanation of proposed procedure or treatment, including risks, serious side effects and treatment alternatives, including request for second opinion.
  • Make informed decisions regarding care and treatment offered to you.
  • Participate in managing your pain effectively.
  • Request a specific treatment.
  • Refuse or discontinue a treatment to the extent permitted by law and to be informed of the consequences of such refusal.
  • Arrangement for transfer to higher level of care (Hospital) should this be necessary, providing full explanation of the need based on your medical condition.
  • Have persons of your choice promptly notified of hospital admission.
  • Accept, refuse or withdraw from clinical research.
  • Choose or change your healthcare provider.
  • Receive care and/or a referral according to the urgency of your situation.

Quality of Care

You have the right to:

  • Respectful treatment, which recognizes and maintains your dignity and personal values.
  • Receiving care in a safe setting.
  • Information and identification of all healthcare personnel providing care to you.
  • Disclosure of who is primarily responsible for your care.
  • Pastoral and/or spiritual support.
  • Interpreters and/or special equipment to assist language needs.
  • Information about continuing healthcare requirements following discharge.

Confidentiality and Privacy

You have the right to:

  • Personal Privacy.
  • Personal information being shared only with those who are involved in your care.
  • Confidentiality of your medical and billing records.

Grievance Process

You and your representative have the right to:

  • Register a complaint with your healthcare providers without a fear of reprisal.
  • Contact Administration at phone number provided here within to file a formal grievance.
  • Receive a timely response with the results of your complaint (when issued to the Center directly).

Colorado Department of Health 303-692-2904 or email:  hfdintake@cdphe.state.co.us

CMS Ombudsman Webpage

Select inquiries/complaint (Medicare recipients)

CMS 1-800-MEDICARE (1-800-633-4227)

To issue a complaint with the Joint Commission for Accreditation go to http://www.jointcommission.org

To obtain information about Advance Medical Directives, please visit www.caringinfo.org or call 1-800-658-8898

Advance Directives

You have the right to know that:

  • Patients treated at Children’s North Surgery Center are expected to be in reasonably good health and of low surgical/procedure risk; making resuscitation appropriate for conditions of preserving life, until transfer to hospital occurs. I understand that my advance directives will not prevent treatment of a life threatening condition should one occur while I am receiving care at Children’s North Surgery Center.  In the event of a life threatening condition, I will be treated, stabilized and transferred via EMS to the closest appropriate acute care facility.

Access to Medical Records

You have the right to:

  • Review and receive a copy of your Medical Records at any time upon written request.

Seclusion and Restraints

You have the right to:

  • Be free of any sort of restraint unless medically necessary.
  • Be free from seclusion or restraint for behavioral management unless there is a need to protect your physical safety or the safety of others.


You have the right to:

  • A complete explanation of your bill.


Providing Information

You have the responsibility to:

  • Provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other health-related matters.
  • Report perceived risks in your care and unexpected changes in your condition.
  • Ask question regarding your treatment plan to become informed before decisions are made.
  • Provide accurate and updated demographic and contact information for insurance and billing.


You have the responsibility to:

  • Actively participate in your treatment by following your recommended treatment plan.

Respect and Consideration

You have the responsibility to:

  • Act in a respectful and considerate manner toward healthcare providers, other patients, and visitors; physical or verbal threats or conduct which is disruptive to business operations will not tolerated.
  • Be respectful of the possessions or property of others.
  • Be mindful of noise levels.

Insurance Billing

You have the responsibility to:

  • Know the extent of your insurance coverage.
  • Know your insurance requirements such as pre-authorization, deductibles and co-payments.
  • Call the billing office with questions or concerns regarding your bill.
  • Fulfill your financial obligations as promptly as possible.

Your physician may have a financial interest in this Surgery Center.

Children’s North Surgery Center is a joint venture between Children’s Hospital Colorado, University Physicians Inc., Children’s Surgery Center, LLC., and Edward Christensen, DDS.