Nondiscrimination & Language Access

Last updated: [LAST UPDATED — to be supplied by the practice]

Our commitment

We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity), consistent with Section 1557 of the Affordable Care Act, Title VI of the Civil Rights Act, Section 504 of the Rehabilitation Act, the Age Discrimination Act, and Title IX.

Free aids and services

• For people with disabilities: qualified sign language interpreters and written information in other formats, such as large print, audio, or accessible electronic formats.
• For people whose primary language is not English: qualified interpreters and information written in other languages.

These services are provided free of charge. Ask any staff member or call (502) 454-8800.

Language assistance taglines

[LANGUAGE TAGLINE SET — the practice must confirm the languages most commonly encountered in its patient population]

ATTENTION: If you speak another language, language assistance services are available free of charge. Call (502) 454-8800.

Filing a grievance

If you believe we failed to provide these services or discriminated in any way, you may file a grievance with our civil rights coordinator:

[CIVIL RIGHTS GRIEVANCE COORDINATOR — to be supplied by the practice]
Louisville Behavioral Health Systems, PLLC, 3430 Newburg Road, Suite 210, Louisville, KY 40218
Phone (502) 454-8800 · Email [PRIVACY OFFICER EMAIL — to be supplied by the practice]

You may file in person or by mail, phone, or email. Our coordinator will help you if you need assistance filing.

Filing with the federal government

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically at the OCR Complaint Portal, 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 (TDD 1-800-537-7697). Complaint forms are available at hhs.gov/ocr/complaints.