Appendix A to Part 92—Sample Notice Informing Individuals About Nondiscrimination
and Accessibility Requirements and Sample Nondiscrimination Statement:

Discrimination is Against the Law

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

Highlands Medical Center:

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 Robert Fanning, 256.218.3779.


If you believe that Highlands Medical Center 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: Robert Fanning, Guest Relations Director, PO Box 1050, Scottsboro, AL 35768, rfanning@jchca.org 
You can file a grievance in person or by mail, or email. If you need help filing a grievance, Robert Fanning, Guest Relations Director 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.


ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame
al 1-866-874-3972


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 1-866-874-3972
 
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame
al 1-866-874-3972


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1-866-874-3972


주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다1-866-874-3972
번으로 전화해 주십시오.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-866-874-3972


ﻢﻗر)  ﻢﻗﺮﺑ ﻞﺼﺗا .نﺎﺠﻤﻟﺎﺑ ﻚﻟ ﺮﻓاﻮﺘﺗ ﺔﯾﻮﻐﻠﻟا ةﺪﻋﺎﺴﻤﻟا تﺎﻣﺪﺧ نﺈﻓ ،ﺔﻐﻠﻟا ﺮﻛذا ثﺪﺤﺘﺗ ﺖﻨﻛ اذإ :ﺔظﻮﺤﻠﻣ
1-866-874-3972
:ﻢﻜﺒﻟاو ﻢﺼﻟا ﻒﺗﺎھ


ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: 1-866-874-3972


ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1-866-874-3972


�ચુ  ના: જો તમે �જ
રાતી બોલતા હો, તો િન:�લ્ક ભાષા સહાય સેવાઓ તમારા માટ� ઉપલબ્ધ છે.
ફોન કરો 1-866-874-3972


PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika
nang walang bayad. Tumawag sa 1-866-874-3972


ध्यान द�:  य�द आप �हदी बोलते ह� तो आपके  िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह�। 1-866-874-3972
पर कॉल कर�।


ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ,
ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-866-874-3972


ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните 1-866-874-3972


ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 
1-866-874-3972


DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz.
1-866-874-3972 irtibat numaralarını arayın.


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。1-866-874-3972まで、お電話にてご連絡ください。