Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement

Discrimination is Against the Law

Muncie Primary Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity, and sex stereotypes (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). Muncie Primary Care does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.

Muncie Primary Care:

• Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services 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 assistance services to people whose primary language is not English, which may include:
  • Qualified interpreters
  • Information written in other languages.

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact the Practice Administrator, Brooklyn Morris.

If you believe that Muncie Primary Care 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: Brooklyn Morris, Practice Administrator; 1910 W. Royale Ave. Muncie, IN 47304; Phone: 765-289-1011, fax: 765-289-3024, bmorris@muncieprimarycare.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Brooklyn Morris 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 Muncie Primary Care’s website: muncieprimarycare.com/section1557

LIMITED ENGLISH PROFICIENCY OF LANGUAGE ASSISTANCE SERVICES

English ATTENTION: If you do not speak English, or you need a sign language interpreter, language assistance services are available to you free of charge. Please tell a staff member that you need an interpreter.

Español ATENCIÓN: Si usted habla Español, tenemos servicios de asistencia idiomática a su disposición, sin cargo. Por favor, comuníquele al personal que necesita un intérprete.

Français ATTENTION : Si vous parlez français, des services d’assistance linguistique gratuits vous sont disponibles. Veuillez signaler à un membre du personnel que vous avez besoin d’un interprète.

ျမန္မာ သတိျပဳရန္။ ။ အကယ္၍ သင္သည္ ျမန္မာ လိိုေျပာပါက ဘာသာစကားဆိုင္ရာအကူအညီ ဝန္ေဆာင္မႈကိို အခမဲ့ ရႏိုင္ပါသည္။ စကားျပန္တစ္ဦးလိိုအပ္ေၾကာင္းကို ေၾကးဇူးျပဳၿပီး ဝန္ထမ္းတစ္ဦးဦးကို ေျပာျပပါ။

Pennsilfaanisch Deitsch ACHTUNG: Wenn Sie sprechen Pennsilfaanisch Deitsch, Übersetzungsdienste sind gratis für Sie vorhanden. Bitte sagen Sie einem Mitarbeiter dass Sie einen Interpreter benötigen.

中文 注意：如果您说中文，我们可为您提供免费的语言帮助服务。请您告诉工作人员您需要一位口语翻译。

Nederlands AANDACHT: Als je Nederlands spreekt, zijn de taal assistentie diensten gratis beschikbaar voor jou. Gelieve een van onze werknemers te vertellen dat je een tolk nodig hebt.

Deutsch ACHTUNG: Wenn Sie lieber Deutsch sprechen, sind Übersetzungsdienste gratis für Sie vorhanden. Bitte sagen Sie einem Mitarbeiter dass Sie einen Interpreter benötigen.

Hakha NGAIHMANH: Hakha holh hmanmi na si ahcun, holh bawmh rianttuannak, man pek haulo, nangmah caah an i manh ko lai. Zangfah tein zung rianttuantu kha holh let na hau tiah chim.

日本語 お知らせ：日本語を話される方は言語補助サービスを無料にてご利用頂けます。通訳が必要な方はスタッフにその旨をお伝えください。

한국인 주의:를 하시면한국인통역 지원 서비스를 무료로 받으실 수 있습니다. 통역사를

이용하시려면 직원에게 말씀해주십시오.

Pусский ВНИМАНИЕ: Если вы говорите на pусский, вам будут предоставлены бесплатные переводческие услуги. Пожалуйста, сообщите сотруднику, что вам нужен переводчик

Tagalog PAUNAWA. Kung ang gamit mong wikà ay Tagalog, mayroóng libreng tulong sa wikà para sa iyó. Magsabi lamang sa isáng kawani na kailangan mo ng tagasalin.

Tiếng Việt CHÚ Ý: Nếu quý vị nói Tiếng Việt, sẽ có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho quý vị. Hãy nói cho thành nhân viên biết nếu quý vị cần người thông ngôn.

العربية انتباه : إنْ كنت تتكلم اللغة ( العربية)، فإنه تتوفر لدينا خدمات اللغة بالمجّان. يُرجى إخبار أحد

أعضاء فريقنا إن كنت بحاجة لمترجم فوريّ ..

हिंदी ध्यान दें: यदि आप हिंदी भाषा बोलते हैं, तो आप के लिए भाषा सहायता सेवाएँ नि:शुल्क, उपलब्ध हैं। कृपया किसी स्टाफ सदस्य को बताएँ कि आपको एक दुभाषिये की जरूरत है।

ਪੰਜਾਬੀ ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਭਾਸ਼ਾ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਤੁਹਾਡੇ ਲਈ ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਸੇਵਾਵਾਂ ਮੁਫ਼ਤ ਵਿਚ ਉਪਲੱਬਧ ਹਨ। ਕਿਰਪਾ ਕਰਕੇ ਕਿਸੇ ਸਟਾਫ਼ ਮੈਂਬਰ ਨੂੰ ਦੱਸੋ ਕਿ ਤੁਹਾਨੂੰ ਇਕ ਅਨੁਵਾਦਕ ਚਾਹੀਦਾ ਹੈ।