ANTI-DISCRIMINATION DISCLAIMER

§1557 of the Affordable Care Act and Nondiscrimination Rule Compliance Manual NOTICE OF NONDISCRIMINATION
Discrimination is Against the Law

Bauman Chiropractic Clinic of Northwest Florida P.A. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This Practice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Bauman Chiropractic Clinic of Northwest Florida P.A. :

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).

Bauman Chiropractic Clinic of Northwest Florida P.A.

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

  • Qualified interpreters; or
  • Information written in other languages.

If you need these services, contact Debbie Daniels - Civil Rights Coordinator.

If you believe that Bauman Chiropractic Clinic of Northwest Florida P.A. 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: Debbie Daniels - Civil Rights Coordinator, 3613 North Hwy 231 Panama City Florida 32404 - 850-785- 8311, Fax - 850-872-9892, Debbie@baumanchiropractic.net. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Debbie DanielsCivil Rights 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, 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, DC 20201, 1–800–868–1019, 800–537–7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html .

Civil Rights Coordinator - Debbie Daniels - (850) 785-8311

Have a disability? Speak a language other than English? Call to get help for free.

Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
Português (Portuguese): ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis.
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。
Français (French): ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.
Tagalog (Tagalog – Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.
Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل :(Arabic (العربیة
برقم. :والبكم الصم ھ
Italiano (Italian): ATTENZIONE: In caso la lingua parlata sia l'italiano, sonodisponibili servizi di assistenza linguistica gratuiti.
Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.
한국어 (Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로이용하실 수 있습니다.번으로 전화해 주십시오
Polski (Polish): UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.
ગુજરાતી (Gujarati): �ચુના: જો તમે�જરાતી બોલતા હો, તો િ◌ન:�લ્કુભાષા સહાય સેવાઓ તમારા માટ�ઉપલબ્ધ છ.
ภาษาไทย (Thai): เรียน: ถ ้าคุณพูดภาษาไทยคุณสามารถใชบริการช ้ วยเหลือทางภาษาได ้ฟรี ่

Section 1557 of the Affordable Care Act Grievance Procedure

It is the policy of Bauman Chiropractic Clinic of Northwest Florida P.A. not to discriminate on the basis of race, color, national origin, sex, age or disability. Bauman Chiropractic Clinic of Northwest Florida P.A. has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Debbie Daniels - Civil Rights Coordinator, 3613 North Hwy 231 Panama City Florida 32404 - 850-785- 8311, Fax - 850-872-9892, Debbie@baumanchiropractic.net who has been designated to coordinate the efforts of Bauman Chiropractic Clinic of Northwest Florida P.A. to comply with Section 1557. Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Bauman Chiropractic Clinic of Northwest Florida P.A. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

Procedure:

  • Grievances must be submitted to the Section 1557 Coordinator within (60 days) of the date the person filing the grievance becomes aware of the alleged discriminatory action.
  • A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
  • The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The
  • Section 1557 Coordinator will maintain the files and records of Bauman Chiropractic Clinic of Northwest Florida P.A. relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
  • The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
  • The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the (Administrator/Chief Executive Officer/Board of Directors/etc.) within 15 days of receiving the Section 1557 Coordinator’s decision. The (Administrator/Chief Executive Officer/Board of Directors/etc.) shall issue a written decision in response to the appeal no later than 30 days after its filing.

The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil

Rights Complaint Portal, which is 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

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Bauman Chiropractic Clinic of Northwest Florida P.A. will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process.