Nondiscrimination and Language Assistance

Our commitment

Sagebrook Pediatrics complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability or sex (including sex characteristics, pregnancy, sexual orientation and gender identity). We do not exclude people or treat them differently because of any of these. Oregon law also protects against discrimination in places of public accommodation, including ours.

Free help for people with disabilities

We provide free aids and services so that people with disabilities can communicate with us effectively, such as:

• Qualified sign language interpreters
• Written information in other formats: large print, audio and accessible electronic formats

We also make reasonable changes to our policies and practices when a disability calls for it. Service animals are welcome in every part of the office.

Free language help

We provide free language services to people whose primary language is not English, such as:

• Qualified interpreters, in person or by phone
• Information written in other languages

Dr. Ruiz Carver and two members of our front desk speak Spanish, and Dr. Raghunathan speaks Tamil and Hindi. For any other language, we book a professional interpreter. You do not need to bring someone to interpret, and we do not ask children to interpret for their parents, except for a moment in an emergency.

How to ask

Tell the front desk when you call (541) 555-0148 (TTY: 711), or tell any member of staff at a visit. We hold extra time for any visit that needs an interpreter.

If you believe we have not treated you fairly

If you believe we have failed to provide these services or discriminated in another way, you can file a grievance with our Section 1557 Coordinator, the practice manager:

Sagebrook Pediatrics, 1174 NW Wall Street, Suite 200, Bend, OR 97703
Phone (541) 555-0148 (TTY: 711) · Fax (541) 555-0149
Email hello@sagebrookpeds.com

You can file a grievance in person, by mail, by phone or by email. If you need help filing it, the coordinator will help you. We answer every grievance in writing within 30 days.

You can also file a civil rights complaint with the Office for Civil Rights:

U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201
Phone 1-800-368-1019 · TDD 1-800-537-7697
Online: the OCR Complaint Portal

Complaint forms are available at hhs.gov/ocr/complaints.

Language assistance

This notice of free language services appears in the 15 languages most spoken in Oregon by people with limited English, as listed by the U.S. Department of Health and Human Services.

• EnglishATTENTION: If you speak a language other than English, free language assistance services are available to you. Call (541) 555-0148 (TTY: 711).
• EspañolATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (541) 555-0148 (TTY: 711).
• Tiếng ViệtCHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (541) 555-0148 (TTY: 711).
• 繁體中文注意：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 (541) 555-0148（TTY：711）。
• РусскийВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (541) 555-0148 (телетайп: 711).
• 한국어주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (541) 555-0148 (TTY: 711) 번으로 전화해 주십시오.
• УкраїнськаУВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (541) 555-0148 (телетайп: 711).
• 日本語注意事項：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。(541) 555-0148（TTY：711）まで、お電話にてご連絡ください。
• العربيةملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم (541) 555-0148 (رقم هاتف الصم والبكم: 711).
• RomânăATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la (541) 555-0148 (TTY: 711).
• ខ្មែរប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ (541) 555-0148 (TTY: 711)។
• Afaan OromooXIYYEEFFANNAA: Afaan dubbattu Oroomiffa yoo ta’e, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa (541) 555-0148 (TTY: 711).
• DeutschACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (541) 555-0148 (TTY: 711).
• فارسیتوجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با (541) 555-0148 (TTY: 711) تماس بگیرید.
• FrançaisATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le (541) 555-0148 (ATS : 711).
• ไทยเรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร (541) 555-0148 (TTY: 711).