As a client/patient of High Country Oxygen, you have the right to:

1. Be fully informed, in advance, about the care and services to be provided, including the disciplines that furnish care, the frequency of visits, and any modifications to your plan of care.

2. Be informed, in advance of care or services being provided, of your financial responsibility, including deductibles, copayments, and coverage criteria. You also have the right to be informed of changes in payment information as soon as possible, but no later than 30 days after High Country Oxygen becomes aware of the change.

3. Receive information about the scope of services that High Country Oxygen provides and any specific limitations on those services.

4. Participate in the development and periodic revision of your plan of care/service.

5. Refuse care or treatment after the consequences of refusing care or treatment have been fully presented to you.

6. Be informed of your rights under Colorado state law to formulate an Advance Directive, if applicable. 7. Have your property and person treated with respect, consideration, and recognition of your dignity and individuality.

8. Be able to identify visiting personnel members through proper identification. All High Country Oxygen personnel will carry and present identification upon request.

9. Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of your property.

10. Voice grievances or complaints regarding treatment, care, lack of respect of property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal.

11. Have any grievance or complaint regarding treatment or care that is (or fails to be) furnished, or lack of respect of property, investigated and resolved by High Country Oxygen.

12. Confidentiality and privacy of all information contained in your client/patient record and of your Protected Health Information (PHI), as described in Part III of this document.

13. Be advised on High Country Oxygen’s policies and procedures regarding the disclosure of clinical records.

14. Choose a healthcare provider, including an attending physician or other licensed practitioner with prescribing authority, if applicable.

15. Receive appropriate patient-centered care in accordance with physician orders.

16. Be informed of any financial benefits when referred to High Country Oxygen.

17. Be fully informed of your responsibilities as outlined below. If you have been adjudged incompetent under Colorado state law by a court of proper jurisdiction, your rights will be exercised by the person appointed to act on your behalf. If a state court has not adjudged you incompetent, any legal

representative you designate in accordance with state law may exercise your rights to the extent allowed by state law.

If you have been adjudged incompetent under Colorado state law by a court of proper jurisdiction, your rights will be exercised by the person appointed to act on your behalf. If a state court has not adjudged you incompetent, any legal representative you designate in accordance with state law may exercise your rights to the extent allowed by state law.