Appendix A to Part 92— Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement
DISCRIMINATION IS AGAINST THE LAW
Marshfield Clinic Health System, Inc. complies with applicable Federal civil rights laws and Wisconsin civil
rights laws and does not unlawfully discriminate on the basis of race, color, national origin, age, disability,
sex, creed, ancestry, sexual orientation, gender identity, marital status, arrest record, conviction record,
genetic information, pregnancy, military service, use or non-use of a lawful product, or declining to attend a
meeting about political or religious matters, and refusal to submit to a lie detector test or performance on a
lie detector test. Marshfield Clinic Health System, Inc. does not exclude people or treat them differently
because of race, color, national origin, age, disability, sex, creed, ancestry, sexual orientation, gender
identity, marital status, arrest record, conviction record, genetic information, pregnancy, military service,
use or non-use of a lawful product, or declining to attend a meeting about political or religious matters, and
refusal to submit to a lie detector test or performance on a lie detector test.
Marshfield Clinic Health System, Inc:
- 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 Paula Pritzl, Director of Employee Relations
at: 800-782-8581 ext. 93393
If you believe that Marshfield Clinic Health System, Inc. 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:
Paula Pritzl, Director of Employee Relations
1000 N. Oak Avenue
Marshfield, WI 54449
Telephone: 800-782-8581 ext. 93393
TTY number 715-384-2140
Fax 715-387-5400
Email: pritzl.pauline@marshfieldclinic.org
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, please contact
Paula Pritzl, Director of Employee Relations at 800-782-8581 ext. 93393 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
a href="tel:+18003681019">1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html
Español (Spanish)
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
- Hojas de datos - sobre las leyes en contra de la discriminación
- Derechos sobre la confidencialidad de la información sobre su salud
繁體中文 (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 (800) 368-1019（TTY 文字電話：1 (800) 537-7697）。
- 事實紙頁- 關於反.視的法律
- 您的健康資訊隱私權
- 您的健康信息隐私权
Tiếng Việt (Vietnamese)
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
- T Thông Tin - v các ðiu lut chng phân bit ði x
- Quyền Bảo mật Thông tin Sức khỏe của Quý vị
한국어(Korean)
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1 (800) 368-1019번 (TTY: 1 (800) 537-7697번)으로 전화하십시오.
- 정보 안내서 -- 차별 금지법에 관한 정보
- 개인의 의료 정보 보호 권리
Nederlands (Dutch)
AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten.
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Shqip (Albanian)
KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë.
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Hmong
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj.
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Tagalog (Tagalog)
PAUNAWA: Kung nagsasalita ka ng Tagalog, may mga libreng serbisyo para sa tulong sa wika na maaari mong gamitin.
Tumawag sa 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
- Paunawa - tungkol sa mga batas laban sa diskriminasyon
- ANG IYONG MGA KARAPATAN SA PAGKAPRIBADO NG IMPORMASYONG PANGKALUSUGAN
Русский (Russian)
ВНИМАНИЕ! Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните по номеру 1 (800) 368-1019 (телетайп: 1 (800) 537-7697).
- Информационные листки о законах, запрещающих дискриминацию
- ВАШИ ПРАВА НА ЗАЩИТУ КОНФИДЕНЦИАЛЬНОСТИ МЕДИЦИНСКОЙ ИНФОРМАЦИИ
العربية (Arabic)
ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل على الرقم 1019-368 (800) 1 (هاتف الصم والبكم: 7697-537 (800) 1)
Kreyòl Ayisyen (French Creole)
ATANSYON Si w pale Kreyòl, gen sèvis èd pou lang gratis ki disponib pou ou.
Rele
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Français (French)
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Appelez le 1 (800) 368-1019 (ATS : 1 (800) 537-7697).
Português (Portuguese)
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis.
Ligue para
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Polski (Polish)
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.
Dzwoń pod numer 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
- Strony informacyjne na temat ustaw o przeciwdziałaniu dyskryminacji
- PRAWA DO OCHRONY PRYWATNOŚCI DANYCH ZDROWOTNYCH
日本語 (Japanese)
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 (800) 368-1019 (TTY:1 (800) 537-7697).
Italiano (Italian)
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Deutsch (German)
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufen Sie uns an unter 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Persian (Farsi)
توجه: اگر به زبان فارسی صحبت می کنید، خدمات یاری رسانی زبانی، بطور رایگان، در دسترس شما می
باشد. با شماره 1 (800) 368-1019 ، (TTY: 1 (800) 537-7697 ) تماس بگیرید.
Pennsylvania Dutch
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff:
1 (800) 368-1019 ، (TTY: 1 (800) 537-7697 )
Romanian
Dacă dumneavoastră sau persoana pe care o asistați aveți întrebări privind [introduceți numele programului SBM], aveți dreptul de a obține gratuit ajutor și informații în
limba dumneavoastră. Pentru a vorbi cu un interpret, sunați la [introduceți numărul aici]. 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Ukrainian
Якщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання про [insert SBM program name], у Вас є право отримати безкоштовну допомогу та інформацію на Вашій рідній
мові. Щоб зв’язатись з перекладачем, задзвоніть на 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Hindi
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं।
1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Laotion
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Urdu
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-1 (800) 368-1019
(TTY: 1 (800) 537-7697).
Somali
KA DIGTOONOW: Haddii aad ku hadasho [insert luqadda], adeegyada kaalmada luqadda, oo lacag la'aan ah, waxaa laga heli karaa in aad. Wac 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Amharic
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1 (800) 368-1019 (TTY: 1 (800) 537-7697).
Telugu
శ్రద్ధ పెట్టండి: ఒకవేళ మీరు తెలుగు భాష మాట్లాడుతున్నట్లయితే, మీ కొరకు తెలుగు భాషా సహాయక సేవలు ఉచితంగా లభిస్తాయి. 1 (800) 368-1019 (TTY: 1 (800) 537-7697) కు కాల్ చేయండి.
