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Notice of Nondiscrimination and Accessibility

Discrimination is Against the Law

Oral Surgery Michiana complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). Oral Surgery Michiana does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.

Oral Surgery Michiana:

  • Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services 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 assistance services to people whose primary language is not English, which may include:
    • Qualified interpreters
    • Information written in other languages

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact the Oral Surgery Michiana Civil Rights Coordinator listed below.

If you believe that Oral Surgery Michiana 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:

Civil Rights Coordinator

Name/Title: Amanda Collins

Mailing Address: 3367 Douglas Rd, South Bend, IN 46635

Telephone: 574-272-8823

You can file a grievance in person or by mail or phone. If you need help filing a grievance, the 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:

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.

This notice is available at Oral Surgery Michiana’s website: www.oralsurgerymichiana.com