(802)334-7331 CONTACT US Language Assistance HomeLanguage Assistance ENGLISH North Country Hospital complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. North Country Hospital does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Attention: You have the right to an interpreter at no cost to you. North Country Hospital: 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 Thom Goodwin. If you believe that North Country Hospital 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: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Thom Goodwin – Director of Quality and Patient Care 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 https://www.hhs.gov/ocr/office/file/index.html. Français ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. North Country Hospital 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. [Name of covered entity] n’exclut et ne traite aucune personne différemment en raison de sa race, sa couleur de peau, son origine nationale, son âge, son sexe ou son handicap. North Country Hospital: • Fournit gratuitement des aides et services aux personnes handicapées afin de permettre une communication efficace avec nous, par exemple: ○ Interprètes qualifiés en langue des signes ○ Informations écrites dans d’autres formats (gros caractères, audio, formats électroniques accessibles, autres formats) • Fournit gratuitement des services linguistiques aux personnes dont la langue principale n’est pas l’anglais, par exemple : ○ Interprètes qualifiés ○ Informations écrites dans d’autres langues Si vous avez besoin de ces services, contactez Thom Goodwin Si vous pensez que North Country Hospital n’a pas fourni ces services ou a fait preuve d’une autre forme de discrimination basée sur la race, la couleur de peau, l’origine nationale, l’âge, le sexe ou le handicap, vous pouvez déposer une réclamation auprès de : Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Vous pouvez déposer une réclamation en personne ou par courrier, télécopie ou e-mail. Si vous avez besoin d’aide pour déposer une réclamation Thom Goodwin – Director of Quality and Patient Care se tient à votre disposition pour vous y aider. Vous pouvez également déposer une réclamation concernant vos droits civiques auprès de l’U.S. Department of Health and Human Services (Département de la Santé et des Services Sociaux des États-Unis), Office for Civil Rights (Bureau des Droits Civiques), par voie électronique via l’Office for Civil Rights Complaint Portal, disponible à l’adresse https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, par courrier ou par téléphone à : 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) Des formulaires de réclamation sont disponibles à l’adresse https://www.hhs.gov/ocr/office/file/index.html. Español ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. North Country Hospital cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. North Country Hospital no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo. North Country Hospital : • Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes: ○ Intérpretes de lenguaje de señas capacitados. ○ Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos). • Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes: ○ Intérpretes capacitados. ○ Información escrita en otros idiomas. Si necesita recibir estos servicios, comuníquese con Thom Goodwin. Si considera que North Country Hospital no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, réclamation Thom Goodwin – Director of Quality and Patient Care está a su disposición para brindársela. También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación: 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) Puede obtener los formularios de reclamo en el sitio web https://www.hhs.gov/ocr/office/file/index.html. 繁體中文 注意:如果您使用繁體中文,您可以免費獲 得語言援助服務 North Country Hospital 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。North Country Hospital 不因種族、膚色、民族血統、年齡、殘障或性別而排斥任何人或以不同的方式對待他們。 North Country Hospital： • 向殘障人士免費提供各種援助和服務，以幫助他們與我們進行有效溝通，如： ○ 合格的手語翻譯員 ○ 以其他格式提供的書面資訊（大號字體、音訊、無障礙電子格式、其他格式） • 向母語非英語的人員免費提供各種語言服務，如： ○ 合格的翻譯員 ○ 以其他語言書寫的資訊 如果您需要此類服務，請聯絡 Thom Goodwin. 如果您認為 North Country Hospital 未能提供此類服務或者因種族、膚色、民族血統、年齡、殘障或性別而透過其他方式歧視您，您可以向 Thom Goodwin – Director of Quality and Patient Care 提交投訴，郵寄地址為189 Prouty Drive, Newport, VT, VT, 05855，電話號碼為 802-334-3295、TTY（聽障專線）號碼為 800-253-0191，傳真為，電子信箱為 Tgoodwin@nchsi.org。您可以親自提交投訴，或者以郵寄、傳真或電郵的方式提交投訴。如果您在提交投訴方面需要幫助，Thom Goodwin – Director of Quality and Patient Care 可以幫助您。 您還可以向 U.S. Department of Health and Human Services（美國衛生及公共服務部）的 Office for Civil Rights（民權辦公室）提交民權投訴，透過 Office for Civil Rights Complaint Portal 以電子方式投訴：https://ocrportal.hhs.gov/ocr/portal/lobby.jsf，或者透過郵寄或電話的方式投訴： 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)（聾人用電信設備） 登入 https://www.hhs.gov/ocr/office/file/index.html 可獲得投訴表格。 Tiếng Việt CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. North Country Hospital 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. [Name of covered entity] không loại trừ mọi người hoặc đối xử với họ khác biệt vì chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính. North Country Hospital : • Cung cấp dịch vụ hỗ trợ miễn phí cho những người khuyết tật để giao tiếp với chúng tôi có hiệu quả, như: ○ Thông dịch viên ngôn ngữ ký hiệu đủ năng lực ○ Thông tin bằng văn bản ở các định dạng khác (chữ in lớn, âm thanh, định dạng điện tử có thể tiếp cận, các định dạng khác) • Cung cấp miễn phí các dịch vụ ngôn ngữ cho những người có ngôn ngữ chính không phải là tiếng Anh, như: ○ Thông dịch viên đủ năng lực ○ Thông tin được trình bày bằng ngôn ngữ khác Nếu bạn cần những dịch vụ này, hãy liên hệ Thom Goodwin. Nếu bạn tin rằng North Country Hospital không cung cấp những dịch vụ này hoặc phân biệt đối xử theo cách khác dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính, bạn có thể nộp đơn khiếu nại với: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Bạn có thể trực tiếp nộp đơn khiếu nại hoặc gửi qua đường bưu điện, chuyển fax, hoặc email. Nếu bạn cần trợ giúp nộp đơn khiếu nại, Thom Goodwin – Director of Quality and Patient Care, sẵn sàng giúp bạn. Bạn cũng có thể nộp đơn khiếu nại về dân quyền lên U.S. Department of Health and Human Services (Bộ Y Tế và Dịch Vụ Nhân Sinh Hoa Kỳ), Office for Civil Rights (Văn Phòng Dân Quyền) bằng hình thức điện tử qua Office for Civil Rights Complaint Portal, có trên trang https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, hoặc qua đường bưu điện hoặc bằng điện thoại tại: 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) Các mẫu khiếu nại có trên trang https://www.hhs.gov/ocr/office/file/index.html. नेपाली ध्या दाहु ोस:् तपयइल े ाेपयल बोलाहु ुुन भाे तपयइक ो मत भयषयसहय्तयसेवयहरशलु करपपयउपलब्न North Country Hospital ले उपयुक्त संघीय अधकारको व्यवस्थासँगै पालन गछर् र वंश, रङ, रािष्ट्रयता, उमेर, अपाङ्गता वा लङ्गको आधारमा भेदभाव गदन । North Country Hospital ले वंश, रङ, रािष्ट्रयता, उमेर, अपाङ्गता वा लङ्गको कारण मानसहरूलाइर् भन्न रूपले व्यवहार वा मानसहरूलाइर् बेवास्ता गदन । North Country Hospital : • यसले हामीसँग प्रभावकार रूपमा संचार गनर् अपाङ्गता भएका मानसहरूलाइर् नःशल्ु क सहायता र सेवाहरू प्रदान गछर्, जस्तैः o योग्य साङ्के तक भाषा अनवु ाद गनहरू o अन्य ढाँचाहरूमा लखत जानकार (ठूलो प्रन्ट, अडयो, सिजलै पहुँच भएको इलेक्ट्रोनक ढाँचाहरू, अन्य ढाँचाहरू) • प्राथमक भाषा अङ्ग्रेजी नभएका मानसहरूलाइर् नःशल्ु क भाषाका सेवाहरू प्रदान गन, जस्तैः o योग्य अनवु ादकहरू o अन्य भाषाहरूमा लखत जानकार तपाइलाइर् यी सेवाहरू आवश्यक छ भने Thom Goodwin मा सम्पकर् गनहुर् ोस् North Country Hospital ले यी सेवाहरू प्रदान गनर् असफल भएको छ अथवा वशं , रङ, रािष्ट्रयता, उमेर, अपाङ्गता वा लङ्गको आधारमा अन्य तरकामा भेदभाव गरेको छ भनेर तपाइले वश्वास गनहुर् ुन्छ भने तपाइले गनु ासो गनर् सक्नहु ुन्छः Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org । तपाइले पत्र,फ्याक्स वा इमेलबाट वा व्यिक्तगत रूपमा गनु ासो गनर् सक्नहु ुन्छ । गुनासो गनर् तपाइलाइर् सहायताको खाँचो छ भने Thom Goodwin – Director of Quality and Patient Care मा तपाइलाइर् सहायता उपलब्ध छ । तपाइले Office for Civil Rights (नागरक अधकारको कायार्लय), U.S. Department of Health and Human Services (य.ु एस. स्वास्थ्य र मानव सेवा वभाग) सँग नागरक अधकारको गुनासो दतार् पन गनर् सक्नुहुन्छ, Office for Civil Rights Complaint Portal को निम्त कायालर् यबाट इलेक्ट्रोनक रूपमा https://ocrportal.hhs.gov/ocr/portal/lobby.jsf मा वा पत्र वा फोनबाट यहाँ उपलब्ध छः 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 (टडड) गनु ासो फाराम https://www.hhs.gov/ocr/office/file/index.html मा उपलब्ध छन् । OBAVJEŠTENJE: Ako govorite srpsko- hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Srpsko-hrvatski North Country Hospital pridržava se važećih saveznih zakona o građanskim pravima i ne pravi diskriminaciju po osnovu rase, boje kože, nacionalnog porijekla, godina starosti, invaliditeta ili pola. [Name of covered entity] ne isključuje ljudi niti ih tretira drugačije zbog njihove rase, boje kože, nacionalnog porijekla, godina starosti, invaliditeta ili pola. North Country Hospital: • Pruža besplatnu pomoć i usluge osobama sa invaliditetom kako bi komunicirali efikasno s nama, poput: ○ kvalifikovanih tumača za znakovni jezik ○ pisanih informacija u drugim formatima (veća slova štampanih materijala, audio format, dostupni elektronski i drugi formati) • Pruža besplatne jezičke usluge osobama čiji maternji jezik nije engleski, poput: ○ kvalifikovanih jezičkih tumača ○ informacija napisanih na drugim jezicima Ako su vam potrebne ove usluge, kontaktirajte Thom Goodwin. Ako mislite da vam North Country Hospital nije pružio ove usluge ili ste bili izloženi diskriminaciji na neki drugi način po osnovu rase, boje kože, nacionalnog porijekla, godina starosti, invaliditeta ili pola, možete podnijeti prigovor sljedećoj ustanovi: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Prigovor možete podnijeti lično, poštom, faksom ili elektronskom poštom. Ako vam je potrebna pomoć za podnošenje prigovora, Thom Goodwin – Director of Quality and Patient Care je dostupan da vam pomogne. Takođe možete podnijeti žalbu u vezi građanskih prava ministarstvu U.S. Department of Health and Human Services (Ministarstvo zdravlja i socijalnih usluga), Office for Civil Rights (Služba za građanska prava) elektronski preko Office for Civil Rights Complaint Portal, dostupnog na https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, ili poštom ili telefonom na: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-868-1019, 800-537-7697 (TDD – Telefon za osobe sa oštećenim govorom ili sluhom) Obrasci žalbe dostupni su na https://www.hhs.gov/ocr/office/file/index.html. Deutsch ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. North Country Hospital erfüllt geltenden bundesstaatliche Menschenrechtsgesetze und lehnt jegliche Diskriminierung aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab. [Name of covered entity] lehnt den Ausschluss oder die unterschiedliche Behandlung von Menschen aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab. North Country Hospital : • Bietet kostenlose Hilfe und Dienstleistungen für Menschen mit Behinderung zur effektiven Kommunikation, wie z. B.: ○ Qualifizierte Gebärdensprachen-Dolmetscher ○ Schriftliche Informationen in anderen Formaten (große Ausdrucke, Audio, zugängliche elektronische Formate, sonstige Formate) • Bietet kostenlose Sprachdienste für Menschen, deren Hauptsprache nicht Englisch ist, wie z. B.: ○ Qualifizierte Dolmetscher ○ Schriftliche Informationen in anderen Sprachen Sollten Sie diese Dienstleistungen benötigen, so wenden Sie sich an Thom Goodwin. Sollten Sie der Ansicht sein, dass North Country Hospital es versäumte, diese Dienstleistungen anzubieten, oder auf sonstige Weise aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht diskriminierte, so können Sie eine Beschwerde einreichen bei: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Sie können eine Beschwerde persönlich oder per Post, Fax oder E-Mail einreichen. Sollten Sie Hilfe beim Einreichen einer Beschwerde benötigen, so steht Ihnen Thom Goodwin – Director of Quality and Patient Care gerne zur Verfügung. Sie können ebenfalls eine Menschenrechtsbeschwerde einreichen bei: Department of Health and Human Services (U.S.-Gesundheitsministerium), Office for Civil Rights (Amt für Bürgerrechte), elektronisch über das Office for Civil Rights Complaint Portal, zugänglich über https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, oder per Post oder telefonisch an: 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) Beschwerdeformulare sind verfügbar unter https://www.hhs.gov/ocr/office/file/index.html. Oroomiffa/Cushite XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. North Country Hospital seera hawwaasummaa Feederaalaan kan wal simu ta’ee sanyii, bifa, dhiigaan, uumriidhaan, yookiin koorniyaadhaan kan wal hin loognee dha. North Country Hospital namoota yookiin sanyii sanyiidhaan, bifaan, dhiigaan, umriidhaan, hir’ina qaamaan yookiin koorniyaadhaan adda hin baasu. North Country Hospital : •Namootni hir’ina garaagaraa qaban bifa gaarii ta’een nu waliin haasa’uu akka danda’aniif deeggarsa fi tajaajila tolaa kennaafii, kanneen akka: ○ Namoota afaan mallattoo haalaan hiikkuu danda’an ○ Odeeffannoo barreeffamaa foormaatii adda ta’een (barreeffama guddaadhaan, sagaleedhaan, foormaatii eleektirooniksii argamuu danda’uun, foormaatii biroo) •Namoota afaan dhalootaa isaanii afaan Ingiliffaa hin taaneef tajaajila afaanii tolaa dhiheessuufi, kanneen akkaL: ○ Warra dandeettii afaan hiikuu gahaa ta’e qaban ○ Odeeffannoo afaanota birootiin barraahe Tajaajila kana yoo barbaadde, Thom Goodwin qunnamaa Kana yoo itti amante North Country Hospital tajajila kana kennuudhaaf hin dandeenye yookiin tajaajila kana kennuu hin dandeenye yookiin sanyiidhaan ,bifaan, dhiigaan, umriidhaan, hiri’ina qaamaan, ykn koorniyaadhaanii fi kanneen birootiin looguu, komii keessan kanneen armaan gadiitiin dhiheessuu ni dandeessu: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. Komii namaan, yookiin poostaadhaan, faaksiidhaan, yookiin e-mail dhaan dhiheessuu ni dandeessa. Komii guutuudhaaf gargaarsa yoo barbaadde Thom Goodwin – Director of Quality and Patient Care si gargarudhaaf qophii dha. Komiiwwan mirga namoomaa U.S. Department of Health and Human Services (Kutaa Fayyaa fi Tajaajila Namoomaa U.S), Office for Civil Rights (Waajjira Mirga Hawwaasummaa) eleektirooniksiidhaan the Office for Civil Rights Complaint Portal, kunis kan argamu https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, ykn poostaadhaan yookiin bilbilaan : U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-868-1019, 800-537-7697 (TDD) Foormiin komiidhaa kan argamu https://www.hhs.gov/ocr/office/file/index.html irratti dha. Italiano ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. North Country Hospital è conforme a tutte le leggi federali vigenti in materia di diritti civili e non pone in essere discriminazioni sulla base di razza, colore, origine nazionale, età, disabilità o sesso. North Country Hospital non esclude le persone o le tratta diversamente a causa di razza, colore, origine nazionale, età, disabilità o sesso. North Country Hospital : • Offre sostegni e servizi gratuiti alle persone affette da disabilità per comunicare con noi in modo efficace, quali: ○ Interpreti qualificati nella lingua dei segni ○ Informazioni scritte in altri formati (stampe a grandi caratteri, audio, formati elettronici accessibili, altri formati) • Offre servizi linguistici gratuiti alle persone la cui lingua primaria non è l’inglese, quali: ○ Interpreti qualificati ○ Informazioni scritte in altre lingue In caso si necessiti di tali servizi, contattare Thom Goodwin. In caso si ritenga che North Country Hospital non abbia offerto tali servizi o abbia posto in essere discriminazioni in altri modi sulla base di razza, colore, origine nazionale, età, disabilità o sesso, è possibile presentare una vertenza a Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. È possibile presentare una vertenza di persona o a mezzo posta, fax oppure e-mail. In caso si necessiti di aiuto per la presentazione della vertenza, Thom Goodwin – Director of Quality and Patient Care è disponibile a fornire assistenza. È altresì possibile presentare un reclamo per i diritti civili allo U.S. Department of Health and Human Services (Dipartimento statunitense per la salute e i servizi umani), Office for Civil Rights (Ufficio per i diritti civili), elettronicamente mediante il Office for Civil Rights Complaint Portal, disponibile all’indirizzo https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, oppure a mezzo posta o telefono all’attenzione di: 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) I moduli di reclamo sono disponibili all’indirizzo https://www.hhs.gov/ocr/office/file/index.html. العربية نإف ،ةغللا ركذا ثدحتت تنك اذإ :ةظوحلم .ناجملاب كل رفاوتت ةیوغللا ةدعاسملا تامدخ يلتزم North Country Hospital بقوانين الحقوق المدنية الفدرالية المعمول بها ولا يميز على أساس العرق أو اللون أو الأصل الوطني أو السن أو الإعاقة أو نوع الجنس. لا يستبعد North Country Hospital الأشخاص أو يعاملهم على نحو مختلف بسبب النوع أو اللون أو الأصل الوطني أو السن أو الإعاقة أو نوع الجنس. North Country Hospital: • يوفر مساعدات وخدمات مجانية للأشخاص من ذوي الإعاقات للتواصل بصورة فعالة معنا، مثل: ○ مترجمي لغة إشارة مؤهلين ○ معلومات كتابية بتنسيقات أخرى (مطبوعة بأحرف كبيرة، مواد صوتية، تنسيقات إلكترونية متيسرة، وغير ذلك من التنسيقات) • يوفر خدمات لغوية مجانية للأشخاص الذين لغتهم الأساسية ليست الإنجليزية، مثل: ○ مترجمين مؤهلين ○ معلومات مكتوبة بلغات أخرى إذا كنت بحاجة لهذه الخدمات، اتصل بـ Thom Goodwin إذا كنت تعتقد أن North Country Hospital قد أخفق في توفير تلك الخدمات أو ميز بطريقة أخرى على أساس العرق أو اللون أو الأصل الوطني أو السن أو الإعاقة أو الجنس، يمكن أن تتقدم بشكوى إلى: Thom Goodwin – Director of Quality and Patient Care, 189 Prouty Drive, Newport, VT, VT, 05855, 802-334-3295, 800-253-0191, Tgoodwin@nchsi.org. يمكن أن تتقدم بشكوى شخصيًا أو بالبريد أو بالفاكس أو البريد الإلكتروني. إذا كنت بحاجة للمساعدة في التقدم بشكوى، فإنThom Goodwin – Director of Quality and Patient Care متاح لمساعدتك. يمكن أيضًا أن تتقدم بشكوى إلكترونيًا لوزارة Department of Health and Human Services (وزارة الخدمات الصحية والبشرية) ، مكتب Office for Civil Rights (مكتب الحقوق المدنية)، من خلال مكتب Office for Civil Rights Complaint Portal، المتوفر على الرابط https://ocrportal.hhs.gov/ocr/portal/lobby.jsf أو بالبريد أو الهاتف على: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-863-1019, 800-537-7697 (رقم هاتف الصم والبكم) تتوافر نماذج الشكاوى على الرابط https://www.hhs.gov/ocr/office/file/index.html. 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