Appendix A to Part 92—Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement:
Discrimination is Against the Law
Southpoint Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Southpoint Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Southpoint Surgery Center:
- 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 Kelly Cameron, Compliance Officer.
If you believe that Southpoint Surgery Center 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:
Kelly Cameron, Compliance Officer
11512 Lake Mead Ave., #534
Jacksonville, FL. 32256
Phone: 904-642-2222
Email: kcameron@floridaeyespecialists.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Kelly Cameron, 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 (opens in new window), 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 here (opens in new window).
Appendix B to Part 92—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-904-398-7205 (TTY: 1-866-268-3297)
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-904-398-7205 (TTY: 1-866-268-3297)
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-904- 398-7205 (TTY: 1-866-268-3297)
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-904-398- 7205 (TTY: 1-866-268-3297)
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 1-904-398-7205 （TTY：1- 866-268-3297)
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-904-398- 7205 (TTY: 1-866-268-3297)번으로 전화해 주십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-904-398-7205 (TTY: 1-866-268-3297)
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-904-398-7205 (телетайп: 1-866-268-3297)
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-904-398-7205 (TTY: 1-866-268-3297)
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-904-398-7205 (ATS : 1-866-268-3297)
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-904-398-7205 (TTY: 1-866-268-3297)
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-904-398- 7205 (TTY: 1-866-268-3297)
ب رق م ات صل .ب ال مجان ل ك ت تواف ر ال لغوی ة ال م ساعدة خدمات ف إن ال لغة، اذك ر ت تحدث ك نت إذا :م لحوظة ھ ال صم وال ب كم: 1-866-268-3297 .(رق م (7205-398
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。1-904-398- 7205（TTY:1-866-268-3297）まで、お電話にてご連絡ください。
ب گ یری د. شما ب رای رای گان ب صورت زب ان ی ت سھ یالت ک ن ید، می گ ف ت گو ف ار سی زب ان ب ھ اگ ر :ت وجھ ف می ب ا شد .ب ا (3297-268-866-1: TTY(7205-398-904-1 ت ماس
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