NOTICE OF NONDISCRIMINATION

Citrus Valley Gastroenterology complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Citrus Valley Gastroenterology does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

• 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)


• 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 [Name of Civil Rights Coordinator].

If you believe that Citrus Valley Gastroenterology 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: [Name and Title of Civil Rights Coordinator], [Mailing Address], [Telephone number ], [TTY number—if covered entity has one], [Fax], [Email]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, [Name and Title of Civil Rights Coordinator] 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:

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.