LEGAL

Proficiency of Language Assistance Services

ATTENTION:  If you speak languages other than English, language assistance services, free of charge, are available to you.  <Insert practice number>

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al <Insert practice number>

D77 baa ak0 n7n7zin: D77 saad bee y1n7[ti’go Diné Bizaad, saad bee 1k1’1n7da’1wo’d66’, t’11 jiik’eh, 47 n1 h0l=, koj8’ h0d77lnih <Insert practice number>

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số <Insert practice number>

ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer<Insert practice number>

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 <Insert practice number>

ملحوظة:  إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم  <Insert practice number>

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  <Insert practice number>번으로 전화해 주십시오.

PAUNAWA:  Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.  Tumawag sa <Insert practice number>

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。<Insert practice number>まで、お電話にてご連絡ください。

ATTENTION :  Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.  Appelez le <Insert practice number>

ATTENZIONE:  In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.  Chiamare il numero <Insert practice number>

ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.  Звоните <Insert practice number>

ध्यान दें:  यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। <Insert practice number>पर कॉल करें।

توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. ب<Insert practice number>تماس بگیرید.

เรียน:  ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี  โทร <Insert practice number>

Discrimination is Against the Law

We comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

We:

• Provide 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)
• Provide 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 Front Office Manager.

If you believe we have 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 HR Director at hr@pediatric.dental. You may also contact the Civil Rights Coordinator if you need help filing a grievance.

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.