Compliance with Section 1557 of the Affordable Care Act. Notice Informing
Individuals regarding OCR Nondiscrimination Requirements. Our practice complies
with applicable Federal civil rights laws and does not discriminate on the
basis of race, color, sex, age, disability, or national origin. Our practice does not exclude people or treat
them differently because of race, color, sex, age, disability, or national
origin. Our practice 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, other formats). Our
practice 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 Valerie Alessandro, DDS.
If you believe that our practice has failed to provide these services or
discriminated in another way on the basis of race, color, sex, age, disability,
or national origin, you can file a grievance with: Valerie Alessandro, DDS, 6
Storrs Rd. PO Box 459, Mansfield Center, CT 06250, 860-456-1808, Fax
860-456-1862. staff@mansfieldfamilydentist.com. You can file a grievance in
person, or by mail, fax, or email. If you need help filing a grievance, Valerie
Alessandro, DDS is available to help you.
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.
Compliance with Section 1557 of the Affordable Care Act. Notice
informing individuals regarding language assistance services. For individuals with limited English
proficiency, we will take reasonable steps to provide free assistance for
languages we are likely to hear.
Spanish:
Si habla español, tiene a su disposición servicios gratuitos de
asistencia lingüística.
Portuguese: Se fala português, encontram-se disponíveis
serviços linguísticos, grátis.
Polish:
Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.
Chinese: 如果您使用繁體中文，您可以免費獲得語言援助服務
Italian:
In caso la lingua parlata sia l'italiano,
sono disponibili servizi di assistenza linguistica gratuiti.
French : Si vous parlez français, des services d'aide
linguistique vous sont proposés gratuitement.
French Creole: Si w pale Kreyòl Ayisyen, gen sèvis èd pou
lang ki disponib gratis pou ou.
Russian: Если вы говорите на русском языке, то вам
доступны бесплатные услуги перевода.
Vietnamese: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ
miễn phí dành cho bạn.
Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.
Korean: 한국어를 사용하시는 경우,
언어 지원 서비스를 무료로 이용하실 수 있습니다.
Albanian:
Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës
gjuhësore, pa pagesë.
Hindi: यदि
आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता
सेवाएं
Tagalog: Kung nagsasalita ka ng
Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad.
Greek: Αν μιλάτε ελληνικά, στη
διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται
δωρεάν.
