Leitchfield Pediatrics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). Leitchfield Pediatrics does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.
Leitchfield Pediatrics:
• Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as:
o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats).
• Provides free language assistance services to people whose primary language is not English, which may include:
o Qualified interpreters
o Information written in other languages.
If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact Haley Stewart. If you believe that Leitchfield Pediatrics 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:
Haley
Stewart
901
Wallace Ave
Leitchfield,
KY
42754
Phone:
270-259-5641
Fax:
270-259-5309
Email:
[email protected]
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Haley Stewart, Assistant Practice Manager, 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.
This notice is available at Leitchfield Pediatric’s website: www.leitchfieldpediatrics.com.