POCONO AMBULATORY SURGERY CENTER POLICY ON CIVIL RIGHTS
Appendix A to Part 92—Notice Informing Individuals about Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law
PASC complies with applicable Federal Civil Rights laws and does not discriminate on the basis of race, color, national origin, age, disability, gender identity, or sex. PASC does not exclude people or treat them differently because of race, color, national origin, age, gender identity, disability, or sex and assures compliance with the Department of Health and Human Services Regulation under the Civil Rights Act of 1964, Title VI, Title IX Education Amendments, Age Discrimination Act of 1975, or Sec. 504 Rehabilitation Act of 1973 or any entity under the ACA Title I.
- 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 at 1800-305-9673
- Information written in other languages
If you need these services, or if you believe that PASC 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: Linda R. Bravyak, RN, NHA, CEO, 1 Storm Street Stroudsburg, Pa. 18360, phone-570-421-4978, Fax- 570-424-7305, or email@example.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Linda R. Bravyak, RN, NHA, Administrator 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.