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Notice of Nondiscrimination

Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement:
Discrimination is Against the Law

Hospice of the Piedmont complies with applicable Federal civil rights laws and does not discriminate on
the basis of race, color, national origin, age, disability, or sex. Hospice of the Piedmont does not exclude
people or treat them differently because of race, color, national origin, age, disability, or sex.
Hospice of the Piedmont:

  • 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 Tammy Patterson, RN, MSN, CHPN, Compliance Officer.

If you believe that Hospice of the Piedmont 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:

Tammy Patterson, RN, MSN, CHPN, Compliance Officer
Hospice of the Piedmont
1801 Westchester Drive
High Point, NC 27262
Phone: 336-889-8446 | Fax: 336889-3450 | info@hospiceofrandolph.org

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Tammy
Patterson, RN, MSN, CHPN, Compliance Officer 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.

Hospice of the Piedmont:

  • 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 Tammy Patterson, RN, MSN, CHPN, Compliance Officer.

Si considera que Hospice of the Piedmont 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:

Tammy Patterson, RN, MSN, CHPN, Compliance Officer
Hospice of the Piedmont
1801 Westchester Drive
High Point, NC 27262
Phone: 336-889-8446 | Fax: 336889-3450
info@hospiceofthepiedmont.org

Si necesita ayuda para hacerlo, Tammy Patterson, RN, MSN, CHPN, Compliance Officer 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

 

English ATTENTION: If you speak [insert language], language assistance services, free of charge, are
available to you. Call 1-336-889-8446

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia
lingüística. Llame al 1-336-889-8446.

繁體中文 (Chinese) 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-336-
889-8446.

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí
dành cho bạn. Gọi số 1-336-889-8446.

한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수
있습니다. 1-336-889-8446. 번으로 전화해 주십시오.

Français (French) ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont
proposés gratuitement. Appelez le 1-336-889-8446.

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-336-889-8446.
(Arabic (ال عرب ية

Hmoob (Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb
rau koj. Hu rau 1-336-889-8446.

Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны
бесплатные услуги перевода. Звоните 1-336-889-8446.

Tagalog (Tagalog – Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga
serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-336-889-8446.

ગજુ રાતી (Gujarati) સચુ ના: જો તમેગજુ રાતી બોલતા હો, તો નન:શલ્ુક ભાષા સહાય સેવાઓ તમારા માટે
ઉપલબ્ધ છે. ફોન કરો 1-336-889-8446.

ខ្មែរ (Cambodian) ប្រយ័ត្ន៖ បរើសិនជាអ្នកនិយាយ ភាសាខ្មែ រ, បសវាជំនួយខ្ននកភាសា បោយមិនគិត្ឈ្ន ួល
គឺអាចមានសំរារ់រំបរ ើអ្នក។ ចូ រ ទូរស័ព្ទ1-336-889-8446.

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-336-889-8446.

ह िंदी (Hindi) ध्यान दें: यदद आप ह िंदी बोलते हैं तो आपके ललए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-336-889-
8446. पर कॉल करें।

ພາສາລາວ (Lao) ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອ
ດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-336-889-8446.

日本語 (Japanese) 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。
1-336-889-8446. まで、お電話にてご連絡ください。