Privacy Practices




HIPPA PRIVACY POLICY


Notice of Nondiscrimination - ACA Section 1557

Discrimination is Against the Law

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

Flat River Family Dentistry:

  • 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 Jessica.

If you believe that Flat River Family Dentistry 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: Jessica, 918 W. Washington St., Greenville, MI  48838; 616-754-3511, Fax:  616-754-2222, e-mail:  frfd1@yahoo.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Jessica 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.



Statement of Nondiscrimination - ACA Section 1557

[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.


Language Assistance Services - English

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx).


Language Assistance Services - Spanish

 ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx).


Language Assistance Services - 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-xxx-xxx-xxxx(TTY:1-xxx-xxx-xxxx)


Language Assistance Services - Korean

 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx)번으로 전화해 주십시오.


Language Assistance Services - Arabic

 ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم -xxx-xxx-xxxx (رقم هاتف الصم والبكم: 1-xxx-xxx-xxxx).


Language Assistance Services - German

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx).


Language Assistance Services - 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-xxx-xxx-xxxx(TTY:1-xxx-xxx-xxxx)まで、お電話にてご連絡ください。


Language Assistance Services - Vietnamese

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


Language Assistance Services - Albanian

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx).