PATIENT RIGHTS STATEMENT IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS

OCR NOTICE OF NONDISCRIMINATION Source: HHS Office for Civil Rights

PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS OF MICHIGAN

complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS OF MICHIGAN

does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS OF MICHIGAN

  • 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)
  • 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 GINA Y. – Civil Rights Coordinator

If you believe that PEDIATRIC DENTISTRY & ORTHODONTIC SPECIALISTS OF MICHIGAN

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:

Gina Y. – Civil Rights Coordinator
39400 Garfield Road – Suite 200, Clinton Township, MI 48038
Telephone number: 586-286-0700
Fax: 586-286-5932
Email: GinaY@mychildsteeth.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance,
Gina Y. – Civil Rights Coordinator is available to help you.

 

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office of Civil rights electronically through the Office of Civil Rights Portal http://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by phone or mail: 1-800-868-1019, (TDD) 800-537-7697.

U.S. Department of Health and Human Services, 200 Independence Avenue SW.
Room 509F, HHH Building Washington, DC 20201.

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

CONSOLIDATED TAGLINE FOR LIMITED ENGLISH PROFICIENCY:

SPANISH:

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-586-286-0700.

ALBANIAN:

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-586-286-0700.

BENGALI:

ল�য্ করনঃ যিদ আপিন বাংলা, কথা বলেত পােরন, তাহেল িনঃখরচায় ভাষা সহায়তা পিরেষবা উপল� আেছ। েফান করন ১-586-286-0700.

CHINESE:

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 1-586-286-0700

GERMAN:

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-586-286-0700.

ITALIAN:

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-586-286-0700.

JAPANESE:

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。1-586-286-0700.

KOREAN:

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-586-286-0700.

번으로 전화해 주십시오.

POLISH:

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-586-286-0700.

RUSSIAN:

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-586-286-0700.

SERBO-CROATIAN:

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-586-286-0700.

TAGALOG:

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-586-286-0700.

VIETNAMESE:

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-586-286-0700.

SYRIAC:

ܙܘܼܗܵܪܵܐ: ܐܸܢ ܐܲܚܬܘܿܢ ܟܹܐ ܗܲܡܙܸܡܝܼܬܘܿܢ ܠܸܫܵܢܵܐ ܐܵܬܘܿܪܵܝܵܐ، ܡܵܨܝܼܬܘܿܢ ܕܩܲܒܠܝܼܬܘܿܢ ܚܸܠܡܲܬܹܐ ܕܗܲܝܲܪܬܵܐ ܒܠܸܫܵܢܵܐ ܡܲܓܵܢܵܐܝܼܬ. ܩܪܘܿܢ ܥܲܠ ܡܸܢܝܵܢܵܐ 1-586-286-0700

ARABIC:

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-586-286-0700(رقم هاتف الصم والبكم:

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