1557 Patient Nondiscrimination



Clarksville Family Eye Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.


Clarksville Family Eye Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.


Clarksville Family Eye Care:

• 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 Karen Ammons.


If you believe that Clarksville Family Eye Care 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:

Karen Ammons,

210 West Main

479.754.3309, 479.754.3955, cfec@outlook.com


You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Karen 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.

Clarksville Family Eye Care cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.


Clarksville Family Eye Care 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。


Clarksville Family Eye Care 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.


Clarksville Family Eye Care 은(는) 관련 연방 공민권법을 준수하며 인종, 피부색, 출신 국가, 연령, 장애 또는 성별을 이유로 차별하지 않습니다.


Sumusunod ang Clarksville Family Eye Care sa mga naaangkop na Pederal na batas sa karapatang sibil at hindi nandidiskrimina batay sa lahi, kulay, bansang pinagmulan, edad, kapansanan o kasarian.


یلتزم [Clarksville Family Eye Careبقوانین الحقوق المدنیة الفدرالیة المعمول بھا ولا یمیز على أساس العرق أو اللون أو الأصل الوطني أو السن أو الإعاقة أو الجنس


Clarksville Family Eye Care 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.


Clarksville Family Eye Care cumpre as leis de direitos civis federais aplicáveis e não exerce discriminação com base na raça, cor, nacionalidade, idade, deficiência ou sexo.


Clarksville Family Eye Care erfüllt geltenden bundesstaatliche Menschenrechtsgesetze und lehnt jegliche Diskriminierung aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab.


Clarksville Family Eye Careは適用される連邦公民権法を遵守し、人種、肌の色、出身国、 年齢、障害または性別に基づく差別をいたしません。 [Name of covered entity]は適用される連邦公民権法を遵守し、人種、肌の色、出身国、 年齢、障害または性別に基づく差別をいたしません。


Clarksville Family Eye Careલા� ુપડતા સમવાયી નાગ�રક અિધકાર કાયદા સાથે�સ ંગત ુ છેઅને �િત, રંગ, રાષ્ટ્ર�ય �ળ, �મર, અશક્તતા અથવા �લ�ગના આધાર� ભેદભાવ રાખવામા ં આવતો નથી.


Clarksville Family Eye Care ua raws cov kev cailij choj yuam siv ntawm Tsom Fwv Nrub Nrab Teb Chaw hais txog pej xeem cov cai (Federal civil rights laws) thiab tsis ciav-cais leejtwg vim nws hom neeg, nqaij tawv, lub tebchaws tuaj, hnub nyoog, kev tsis taus, los yog poj niam txiv.


Clarksville Family Eye Care eo ej pokake kien an Federal in jimwe ko an armej im ejjab kalijekḷọk kōn wōn armej, kaḷar, aelōñ, jete an iiō, jipikpik, ak ñe eṃṃaan ak kōrā


Clarksville Family Eye Care ປະຕິບັດຕາມກົດໝາຍວ່າດ້ວຍສິດທິພົນລະເມືອງຂອງຣັຖບານກາງທີ່ບັງ ຄັບໃຊ້ ແລະບໍ່ຈຳແນກໂດຍອີງໃສ່ພື້ນຖານດ້ານເຊື້ອຊາດ, ສີຜິວ, ຊາດກຳເນີດ, ອາຍຸ, ຄວາມພິການ, ຫຼື ເພດ.
Clarksville Family Eye Care लागूहोने योग्य संघीय नाग�रक अिधकार क़ाननू का पालन करता ह ै और जाित, रंग, रा�ीय मूल, आयु, िवकलांगता, या �लग के आधार पर भेदभाव नह� करता ह।

Clarksville

Family Eye Care