NONDISCRIMINATION AND ACCESSIBILITY REQUIREMENTS NOTICE
Appendix A to Part 92—Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement:
Discrimination is Against the Law
Jax Spine & Pain Centers complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Jax Spine & Pain Centers does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Jax Spine & Pain Centers:
- 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 Leslie Faulk, HR Manager
If you believe that Jax Spine & Pain Centers 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:
Leslie Faulk, HR Manager
10475 Centurion Pkwy N Suite 201, Jacksonville, FL 32256
904-256-2736, or email LeslieF@JaxSpine.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Leslie Faulk, HR 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.
Appendix B to Part 92—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 904-294-4834
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 904-294-4834
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 904-294-4834
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 904-294-4834
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 904-294-4834
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 904-294-4834번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 904-294-4834
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 904-294-4834
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 904-294-4834
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 904-294-4834
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 904-294-4834
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 904-294-4834
ةظوحلم:إ ك اذ ت تن ا ثدحت ا ركذ ف ،ةغلل خ نإ ا تامد ا ةدعاسمل ت ةیوغلل ل رفاوت ب ك ناجملا.ا ب لصت مقر1-904-294-4834 ) ر مق. 904-294-4834 : ا مكبلاو ھ مصل
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。904-294-4834 まで、お電話にてご連絡ください。
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