Review draft — not an adopted public notice. Facility approval and completion are required before publication.
Nondiscrimination
OrthoSurg ASC LLC complies with applicable federal civil rights laws. Under the facility's nondiscrimination policy, the center does not exclude people or treat them less favorably because of race, color, national origin, age, disability or sex, including pregnancy, sex stereotypes or gender identity.
This statement describes the facility's proposed policy commitments; the policy must be formally approved before this draft is published.
Free language and communication assistance
The center provides appropriate auxiliary aids and services, such as qualified sign language interpreters and information in appropriate accessible formats, to help people with disabilities communicate effectively. The center also provides language assistance, such as qualified interpreters and appropriate written translations, for people whose primary language is not English.
These services are available without charge. Tell staff what you need or call 812-401-9171. Read the assistance notice in English and 15 languages.
Report a civil rights concern
If you believe the center has failed to provide these services or has discriminated against you, you may file a grievance with the Civil Rights Coordinator. Call 812-401-9171 and ask to be connected, or write to OrthoSurg ASC LLC, Attention: Civil Rights Coordinator, 300 Circle Front Dr., Evansville, IN 47715. Fax: 812-401-9175. General email: general@myorthosurg.com. Please call for a secure way to transmit sensitive information.
You can make your grievance in person, by mail, by fax or by email. Ask staff for help with the process or an accessible way to communicate. You will not be retaliated against for requesting assistance or raising a concern.
You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, through the OCR Complaint Portal, by phone at 1-800-368-1019 (TDD: 1-800-537-7697), or by mail to 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201. Complaint forms and instructions are available from HHS.