Draft — effective date to be set by the practice
Our commitment
1234 Ortho-K Vision Care complies with applicable federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
Free help for people with disabilities
We provide free aids and services to people with disabilities so they can communicate with us effectively, such as:
- Qualified sign language interpreters
- Written information in other formats, such as large print, audio or accessible electronic formats
Free language services
We provide free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
How to get these services
If you need any of these services, please call our office at (626) 282-5388 or toll-free at (800) 991-8881. If you are deaf or hard of hearing, you can reach us through the California Relay Service by dialing 711.
How to file a grievance with us
If you believe that we have failed to provide these services or discriminated against you in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with our Privacy Officer:
- Privacy Officer, 1234 Ortho-K Vision Care
- Mail or in person: 1234 S. Garfield Ave. #105, Alhambra, CA 91801
- Phone: (626) 282-5388
You can file a grievance in person, by mail or by phone. If you need help filing a grievance, our Privacy Officer is available to help you.
How to file a civil rights complaint with the federal government
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
- Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
- Phone: 1-800-368-1019, 800-537-7697 (TDD)
- Mail: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201
Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html.
Language assistance
- ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (626) 282-5388.
- 注意：如果您使用繁體中文，您可以免費獲得語言協助服務。請致電 (626) 282-5388。
- 注意：如果您使用简体中文，您可以免费获得语言协助服务。请致电 (626) 282-5388。
- 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (626) 282-5388 번으로 전화해 주십시오.
- CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (626) 282-5388.
- PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (626) 282-5388.
- ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ։ Զանգահարեք (626) 282-5388։
- 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。(626) 282-5388 までお電話ください。