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Tue, May 02, 2017
Vital Signs
 

Notice of Nondiscrimination

 

Peninsula Internal Medicine, PC, complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Peninsula Internal Medicine, PC, does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Peninsula Internal Medicine, PC

 

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters or
    • 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 (see below).

If you need these services, contact our Section 1557 Coordinator(s): Kathleen Stephenson or Patty Besse, at 907-262-8597.

 

If you believe that Peninsula Internal Medicine, PC, 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 our two Section 1557 Coordinators: Kathleen Stephenson or Patty Besse. You can file a grievance in person or by mail, phone or email. If you need help filing a grievance, Kathleen Stephenson or Patty Besse 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

Language Assistance Services

ATTENTION: If you speak – Tagalog, Español, 한국어, Hmoob, Русский, 繁體中文, Gagana fa’a Sāmoa, ພາສາລາວ, 日本語, Ilokano, Tiếng Việt, Українська, ภาษาไทย, Deutsch, or Polski – language assistance services are available to you, free of charge. Call 1-907-262-8597.

Tagalog

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-907-262-8597.

Spanish

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-907-262-8597.

Korean

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-907-262-8597. 번으로 전화해 주십시오.

Hmong

LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj.   Hu rau 1-907-262-8597.

Russian

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-907-262-8597.

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 1-907-262-8597.

Samoan

MO LOU SILAFIA: Afai e te tautala Gagana fa’a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi, mo oe, Telefoni mai: 1-907-262-8597.

Laotian

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-907-262-8597.

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。 1-907-262-8597. まで、お電話にてご連絡ください。

Ilokano

PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 1-907-262-8597.

Vietnamese

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-907-262-8597.

Ukrainian

УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-907-262-8597.

Thai

เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-907-262-8597.

German

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-907-262-8597.

Polish

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-907-262-8597.

SECTION 1557 of the Affordable Care Act Grievance Procedure

 

It is the policy of Peninsula Internal Medicine, PC not to discriminate on the basis of race, color, national origin, sex, age or disability. Peninsula Internal Medicine, PC has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of “Section 1557 Coordinator(s)”: Patty Besse or Kathleen Stevenson,247 N. Fireweed Ste. A, Soldotna, AK 99669, 1-907-262-8597 [Telephone], 907-262-6516 [Fax], designated to coordinate the efforts of Peninsula Internal Medicine, PC to comply with Section 1557.

 

Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Peninsula Internal Medicine, PC to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

 

Procedure:

 

Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.

 

A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.

 

The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Peninsula Internal Medicine, PC relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.

 

The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.

 

The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the Board of Directors within 15 days of receiving the Section 1557 Coordinator’s decision. The Board of Directors shall issue a written decision in response to the appeal no later than 30 days after its filing.

 

The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is 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

 

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination.

 

Peninsula Internal Medicine, PC will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Dated: 10/16/2016