Vision Source Baxley Nondiscrimination Statement

Download a copy of our Nondiscrimination Statement [PDF]

Vision Source Baxley understands that discrimination is against the law and complies with all applicable Federal and State civil rights laws. Specifically, we do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude patients or treat them any differently based on any of these factors.

When necessary and free of charge to the patient, Vision Source Baxley

• Provides aids and services to patients with disabilities when necessary to effectively communicate with them

• Provides qualified sign language interpreters for hearing impaired patients

• Provides language services to those patients who cannot effectively communicate in English. This may include qualified interpreters or written information.

If you believe Vision Source Baxley has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you may file a grievance with:

Ashley Carter

510 S. Main St. Suite A Baxley, GA 31513

912-705-2020 Fax 912-705-2022

drlovett@atc.cc

You may file your grievance in person, by mail, fax or email. If you need assistance filing a grievance, Ashley Carter is available to assist you. You may also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights two ways:

(1) Electronically through the Office of Civil Rights Complaint Portal:

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

(2) By mail or phone at:

US Department of Health and Human Services

200 Independence Avenue SW Room 509F, HHH Building

Washington, DC 20201

1-800-368-1019 1-800-537-7697 (TDD)

Complaint forms are available at:

http://www.hhs.gov/ocr/office/file/index.html

Vision Source Baxley

Individuals With Limited English Proficiency

Information Regarding Language Assistance Services

ATTENTION: If you speak any of the following languages, language assistance services are available (free of charge) to you upon request.

Español (Spanish)

Tiếng Việt  (Vietnamese)

한국어  (Korean)

繁體中文  (Chinese)

ગુજરાતી (Gujarati)

Français (French)

አማርኛ  (Amharic)

हिंदी (Hindi)

Kreyòl Ayisyen  (French Creole)

Русский  (Russian)

العربية(Arabic)

Português (Portuguese)

(Farsi)فارسی

(Deutsch (German

日本語  (Japanese)