NONDISCRIMINATION STATEMENT
Sierra Eye Medical Group, Inc. (Sierra Eye Group) and Sierra Ambulatory Surgery Center, A Medical Corp (SASC) comply with Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Sierra Eye Group does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Sierra Eye Group and SASC
•Provides fee 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 Rosalia Campos.
If you believe that Sierra Eye Group or SASC 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 Rosalia Campos, 2830 W. Main St., Visalia, CA 93291-4331, 559-636-1000, FAX 559-636-3937 or email at segrcampos@gmail.com. You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Rosalia Campos 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 Compliant 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
1-800-368-1119, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Proficiency of Language Assistance Services
(Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-559-636-1000.
(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 1-559-636-1000.
(Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-559-636-1000.
(Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-559-636-1000.
(Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-559-636-1000번으로 전화해 주십시오.
(Armenian) ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-559-636-1000.
(Persian-Farsi) توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما .بگیرید تماس 1-559-636-1000 با. باشد می فراھم
(Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-559-636-1000.
(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。1-559-636-1000まで、お電話にてご連絡ください.
(Arabic) ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-559-636-1000 رقم والبكم الصم ھ
(Panjabi) ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ� ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤ� ਭਾਸ਼ਾ ਿਵੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-559-636-1000
(Cambodian) ្របយ័ត�៖ េបើសិន�អ�កនិ�យ ��ែខ� រ, េស�ជំនួយែផ�ក�� េ�យមិនគិតឈ� �ល គឺ�ច�នសំ�ប់បំេរ �អ�ក។ ចូរ ទូរស័ព� 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx)។
(Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1- 559-636-1000.
(Hindi) ध्यान द�: य�द आप �हदी बोलते ह � तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह।� 559-636-1000.
(Thai) ียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-559-636-1000
Sierra Eye Medical Group, Inc. (Sierra Eye Group) and Sierra Ambulatory Surgery Center, A Medical Corp (SASC) comply with Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Sierra Eye Group does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Sierra Eye Group and SASC
•Provides fee 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 Rosalia Campos.
If you believe that Sierra Eye Group or SASC 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 Rosalia Campos, 2830 W. Main St., Visalia, CA 93291-4331, 559-636-1000, FAX 559-636-3937 or email at segrcampos@gmail.com. You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Rosalia Campos 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 Compliant 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
1-800-368-1119, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Proficiency of Language Assistance Services
(Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-559-636-1000.
(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 1-559-636-1000.
(Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-559-636-1000.
(Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-559-636-1000.
(Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-559-636-1000번으로 전화해 주십시오.
(Armenian) ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-559-636-1000.
(Persian-Farsi) توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما .بگیرید تماس 1-559-636-1000 با. باشد می فراھم
(Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-559-636-1000.
(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。1-559-636-1000まで、お電話にてご連絡ください.
(Arabic) ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-559-636-1000 رقم والبكم الصم ھ
(Panjabi) ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ� ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤ� ਭਾਸ਼ਾ ਿਵੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-559-636-1000
(Cambodian) ្របយ័ត�៖ េបើសិន�អ�កនិ�យ ��ែខ� រ, េស�ជំនួយែផ�ក�� េ�យមិនគិតឈ� �ល គឺ�ច�នសំ�ប់បំេរ �អ�ក។ ចូរ ទូរស័ព� 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx)។
(Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1- 559-636-1000.
(Hindi) ध्यान द�: य�द आप �हदी बोलते ह � तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह।� 559-636-1000.
(Thai) ียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-559-636-1000