such as cognitive, hearing, vision, or print impairments. (10) Access to English as a second language, foreign language, and sign language interpreters, translated and alternative format documents, readers, and other auxiliary aids and services, are essential to ensure effective communication and eliminate the language barriers that impede access to health care. (11) Competent language services in health care settings should be available as a matter of course. 202. Improving access to services for individuals with limited English proficiency (a) Purpose Consistent with the goals provided in Executive Order 13166 ( 42 U.S.C. 2000d–1 note