Effingham Ambulatory Surgery Center Nondiscrimination Notice

Effingham Ambulatory Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression. Effingham Ambulatory Surgery Center does not exclude people or treat them differently because of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression.  Our health plans are also subject to the section 1557 nondiscrimination requirements and will be operated accordingly.

Effingham Ambulatory Surgery Center:

Provides free auxiliary aids and services to people with disabilities to communicate effectively with us, such as —

• Qualified sign language interpreters, video remote interpreting or other aids for hearing impaired individuals.
• Written information in multiple formats including large print, audio, accessible electronic formats, or other formats for visually impaired individuals.

Provides free language services to people whose primary language is not English, such as —

• Qualified interpreters or a language line.
• Information written in other languages.

If you need these services, contact Effingham Ambulatory Surgery Center’s ADA Coordinator at (217) 342-1234.

If you believe that Effingham Ambulatory 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 can file a grievance with our coordinator:

ADA Coordinator
Effingham Ambulatory Surgery Center
904 West Temple 
Effingham, Illinois 62401
Phone: (217) 342-1234
Fax: (217) 342-1230
JDunaway@uspi.com

You can file a grievance in person or by mail, fax or email.  If you need help filing a grievance, Effingham Ambulatory Surgery Center’s ADA Coordinator 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, or by mail or phone:

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 here

English

ATTENTION:  If you speak another language, language assistance services, free of charge, are available to you. Call 1(217) 342-1234

Spanish

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1(217) 342-1234

Polish

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1(217) 342-1234

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(217) 342-1234

Korean

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1(217) 342-1234 번으로 전화해 주십시오.

Tagalog

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1(217) 342-1234

Arabic

ملحوظة:  إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم 1 1(217) 342-1234

Russian

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1(217) 342-1234

Gujarati

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1(217) 342-1234

Urdu

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1(217) 342-1234

Vietnamese

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1(217) 342-1234

Italian

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1(217) 342-1234

Hindi

ध्यान दें:  यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।1(217) 342-1234 पर कॉल करें।

French

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1(217) 342-1234

Greek

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1(217) 342-1234

German

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1(217) 342-1234