Statement of Non-Discrimination
· Proliance Surgeons does not discriminate on the basis of race, color, national origin, sex, age, disability or limited English proficiency in its health programs and activities.
· Proliance Surgeons provides appropriate auxiliary aids and services including qualified interpreters for individuals with disabilities and information in alternative formats, free of charge and in a timely manner, when such aids and services are necessary to ensure an equal opportunity to participate to individuals with disabilities.
· Proliance Surgeons provides language assistance services, including translated documents and oral interpretation, free of charge and in a timely manner, when such are necessary to provide meaningful access to individuals, with limited English proficiency.
· Proliance Surgeons can assist in obtaining the aids and services described above.
If you need these services, please contact the Clinic Administrator.
If you believe that Proliance Surgeons has failed to provide these services or discriminated in another way on the basis of race, color, national origin, sex, age or disability, you can file a grievance with Proliance’s Civil Rights Coordinator, 805 Madison St, Suite 901, Seattle, WA 98104, 1-888-608-7344, 1-206-264-8689 (fax), or email at email@example.com. You can file your grievance in person or by mail, fax, or email. If you need help filing a grievance, Proliance’s Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the US Dept. of Health & Human Services, Office of Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby, or US Dept of Health & Human Services, 200 Independence Ave, SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD) or https://www.hhs.gov/ocr/office/file/index.html.