Notice of Patient Nondiscrimination

Central Florida Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Young Vision Care does not exclude or treat individuals differently because of race, color, national origin, age, disability, or sex.

Central Florida Surgery Center:

1. 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)

2. Provides free language services to people whose primary language is not English, such as:

• Qualifiedinterpreters

• Information written in other languages

If you need these services, contact by email

If you believe that Central Florida Surgery 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 may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Electronically

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Mail

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

Phone

1-800-368-1019, 800-537-7697 (TDD)

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Llame al (863) 686-3344

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

(863) 686-3344

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.

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ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.

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(863) 686-3344

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le

(863) 686-3344

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ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

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