Nondiscrimination and Accessibility Requirements
Appendix A to Part 92— Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law
A Pineywoods Home Health Care, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. A Pineywoods home Health Care, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
A Pineywoods Home Health Care, Inc.:
- 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 Deadra Hambrick, Civil Rights Coordinator.
If you believe that A Pineywoods Home Health Care, Inc. 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: Deadra Hambrick, Civil Rights Coordinator, 103 B Carriage Drive, Lufkin Texas, 75904, 936-634-1617, 936-634-7967, [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Deadra Hambrick, 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: 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.
Nondiscrimination statement for significant publications and signification communications:
A Pineywoods Home Health Care, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Appendix B to Part 92—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services
ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-936-634-1617.
Appendix A to Part 92— Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law
A Pineywoods Home Health Care, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. A Pineywoods Home Health Care, inc. no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.
A Pineywoods Home Health Care, Inc.:
- Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes: Intérpretes de lenguaje de señas capacitados.
- Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).
- Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes: Intérpretes capacitados.
- Información escrita en otros idiomas.
Si necesita recibir estos servicios, comuníquese con Deadra Hambrick.
Si considera que A Pineywoods home Health Care, Inc. no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Deadra Hambrick, 103-B Caaiage Drive, Lufkin, Texas 75904, 936-634-1617, 936-634-7967, [email protected]. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, [Name and Title of Civil Rights Coordinator] está a su disposición para brindársela.
También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación: 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)
Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.
Data will print a current active patient list for highlighting as each patient is informed and copy is placed in their home folder.
Place a copy of this notice in every CURRENT PATIENT home chart. Document in clinical notes that the patient has been provided the notice:
Clinical Note charting:
Notice Informing Individuals about Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement: Discrimination is Against the Law information was placed in the patient’s home chart and the patient was informed of the information.
DATA: will add this sheet to the sample patient’s home chart information and new admit chart home chart information.
Clinical Directors please in-service your staff and send the completed in-service to your Regional Director.
After the active patient list is completed and all patients have the notice in the home folders, send the completed highlighted list to your Regional Director for tracking.
Place the original in your forms book for future use.
