DISCRIMINATION IS AGAINST THE LAW
Island Endoscopy Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Island Endoscopy Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Island Endoscopy Center provides free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign language interpreters and some written information in other formats upon request (large print, accessible electronic formats, other formats). We provide free language services to people whose primary language is not English, such as: qualified interpreters.
If you need these services, you may contact Marianne Jorgensen. If you believe that Island Endoscopy Center 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:
Marianne Jorgensen
1175 Montauk Highway
West Islip, NY 11795
OR (631) 376 0001 ext. 11
You can file a grievance in person or by mail or phone. If you need help filing a grievance, Marianne Jorgensen is available to assist 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
1-800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
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Island Endoscopy Center cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Island Endoscopy Center no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.
Island Endoscopy Center proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes: intérpretes de lenguaje de señas capacitados. Información escrita en otros formatos (letra grande, formatos electrónicos accesibles, otros formatos). Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes: Intérpretes capacitados. Información escrita en otros idiomas.
Si necesita recibir estos servicios, comuníquese con Marianne Jorgensen. Si considera que Island Endoscopy Center no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Marianne Jorgensen alas 1175 montauk Highway West Islip, NY 11795 or (631) 376-0001 ext. 11. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, Marianne Jorgensen está a su disposición para brindársela.
También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación: 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). Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.
ATTENTION:
If you speak English, language assistance services, free of charge, are available to you. Call 772-398-9898.
ATENCIÓN Español (Spanish):
Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (631)376-0001 .
Kreyòl Ayisyen (French Creole):
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-631 376-0001
Tiếng Việt (Vietnamese):
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-(631) 376-0001 ext. 11.
Português (Portuguese):
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (631) 376-0001 ext. 11.
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
(631) 376-0001 ext. 11
Français (French): Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-(631) 376-0001 ext. 11
Tagalog (Tagalog – Filipino):
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-(631) 376-0001 ext. 11.
Русский (Russian):
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-(631) 376-0001 ext. 11.
رقم (Arabic): (631) 376-0001 ext. 11- ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم.
Italiano (Italian):
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-(631) 376-0001 ext. 11.
Deutsch (German):
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-(631) 376-0001 ext. 11
한국어 (Korean):
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-(631) 376-0001 ext. 11. 번으로 전화해 주십시오.
Polski (Polish):
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-(631) 376-0001 ext. 11.
ગુજરાતી (Gujarati):
?ચુના: જો તમે ?જરાતી બોલતા હો, તો િન:?લ્કુ ભાષા સહાય સેવાઓ તમારા માટ? ઉપલબ્ધ છ. ફોન કરો 1-(631) 376-0001 ext. 11.
ภาษาไทย (Thai):
เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-(631) 376-0001 ext. 11.
It is the policy of Island Endoscopy Center not to discriminate on the basis of race, color, national origin, sex, age or disability. Island Endoscopy Center has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services.
Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of:
Marianne Jorgensen, Administrator of Section 1557 Coordinator
1175 Montauk Highway
West Islip, NY 11795
Phone: (631) 376-0001
Fax: (631) 376-0003
Email: marianne.jorgensen@islandendoscopy.com
Marianne Jorgensen has been designated to coordinate the efforts of Island Endoscopy Center to comply with Section 1557.
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Island Endoscopy Center to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is 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
Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination.
Island Endoscopy Center will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.
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Dated: October 12, 2016
Marianne Jorgensen,
Administrator
