NOTICE INFORMING INDIVIDUALS ABOUT NONDISCRIMINATION AND ACCESSIBILITY REQUIREMENTS AND SAMPLE NONDISCRIMINATION STATEMENT
DISCRIMINATION IS AGAINST THE LAW
Belmont / Harlem 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. Belmont / Harlem Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
BELMONT / HARLEM SURGERY CENTER:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
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Qualified sign language interpreters
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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:
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Qualified interpreters (Click here to see available languages.)
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Information written in other languages
If you need these services, contact Belmont Harlem’s Civil Rights Coordinator Designee.
If you believe that Belmont Harlem 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:
Belmont / Harlem Surgery Center
c/o Civil Rights Coordinator
3101 - 3115 N. Harlem Ave. (Main Floor)
Chicago, IL 60634
(773) 889-2000
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Belmont
Harlem’s Civil Rights Coordinator 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 the
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf website, and 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 the http://www.hhs.gov/ocr/office/file/index.html website.
BELMONT / HARLEM SURGERY CENTER (BHSC) NON DISCRIMINATION STATEMENT AND REQUIRED NON ENGLISH LANGUAGES
English BHSC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color,
national origin,age, disability, or sex.
ATTENTION: If you speak any language that requires language assistance services, free of charge, are available to
you. Call 1-773-889-2000.
Español (Spanish) BHSC cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-773-889-2000.
Polski (Polish) BHSC postępuje zgodnie z obowiązującymi federalnymi prawami obywatelskimi i nie dopuszcza się
dyskryminacji ze względu na rasę, kolor skóry, pochodzenie, wiek, niepełnosprawność bądź płeć.
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-773-889-2000.
Tagalog (Tagalog – Filipino) Sumusunod ang BHSC sa mga naaangkop na Pederal na batas sa karapatang sibil at hindi
nandidiskrimina batay sa lahi, kulay, bansang pinagmulan, edad, kapansanan o kasarian.
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-773-889-2000
ᔺc/uӾ (Chinese) BHSC 遵守適用的聯邦民權法律規定,不因種族、膚色、民族血統、年齡、殘障或性別而歧視任何
人。
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 1-773-889-2000。
Deutsch (German) BHSC erfüllt geltenden bundesstaatliche Menschenrechtsgesetze und lehnt jegliche Diskriminierung
aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab.
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-773-889-2000
한국어 (Korean) BHSC 은(는) 관련 연방 공민권법을 준수하며 인종, 피부색, 출신 국가, 연령, 장애 또는 성별을 이유로 차별하지 않습니다.
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-773-889-2000 번으로 전화해 주십시오.
(Arabic)
بقوانین الحقوق المدنیة الفدرالیة المعمول بھا ولا یمیز على أساس العرق أو اللون أو BHSC یلتزم
رقم) xxx-xxx-xxxx-1 ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم
0002-988-377-1 هاتف الصم والبكم
اُردُو (Urdu)
قابلِ اطلاق وفاقی شہری حقوق کے قوانین کی تعمیل کرتا ہے اور یہ کہ نسل، رنگ ، قومیت، عمر، معذوری یا جنس کی بنیاد پر امتیاز نہیں کرتا۔ BHSC
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-377-988-0002.
Русский (Russian) BHSC соблюдает применимое федеральное законодательство в области гражданских прав и не
допускает дискриминации по признакам расы, цвета кожи, национальной принадлежности, возраста, инвалидности или пола.
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните
1-773-889-2000
Italiano (Italian) BHSC è conforme a tutte le leggi federali vigenti in materia di diritti civili e non pone in essere discriminazioni sulla base di razza, colore, origine nazionale, età, disabilità o sesso.
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il
numero 1-773-889-2000
ગuજરાતી (Gujarati) BHSC લાગuપડતા સમવાયી નાગિરક અિધકાર કાયદા સા5 6સ7ગત 8 અ9 :િત, ર7ગ, રા;ીય <ળ, uમર, અશ@તા
અથવા iલગના આધાD Eદભાવ રાખવામા7આવતો નથી.
6ચના: J તK ગuજરાતી બોલતા હો, તો િન:શuNક ભાષા સહાય Pવાઓ તમારા માR ઉપલTધ 8. ફોન કરો 1-773-889-2000.
λληνικά (Greek) Η BHSC συμμορφώνεται με τους ισχύοντες ομοσπονδιακούς νόμους για τα ατομικά δικαιώματα και δεν προβαίνει σε διακρίσεις με βάση τη φυλή, το χρώμα, την εθνική καταγωγή, την ηλικία, την αναπηρία ή το φύλο.
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-773-889-2000.
िहंदी (Hindi) BHSC लागूहोनेयोग संघीय नागिरक अिधकार क़ानून का पालन करता हैऔर जाित, रंग, राषीय मूल, आयु, िवकलांगता, या िलंग के
आधार पर भेदभाव नही करता है।
धान दे: यिद आप िहंदी बोलतेहैतो आपकेिलए मुफ मेभाषा सहायता सेवाएं उपलब है। 1-773-889-2000 पर कॉल करे।
Français (French) BHSC respecte les lois fédérales en vigueur relatives aux droits civiques et ne pratique aucune discrimination basée sur la race, la couleur de peau, l'origine nationale, l'âge, le sexe ou un handicap.
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le
1-773-889-2000.
Tiếng Việt (Vietnamese) BHSC tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-773-889-2000.