Non Discrimination Notice at Urgent Care & Walk-in Clinic in Morristown, TN

Notice and Non-Discrimination Statement

AFC Urgent Care/Family Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AFC Urgent Care/Family Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AFC Urgent Care/Family Care:

• 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
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreter services
  • Information written in other languages

If you need these services, please notify clinic staff.

If you believe that AFC Urgent Care/Family Care 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:

Jack Fromm, Compliance Officer
Email: jfromm@afcurgentcare.com

David Farlett, Chief Financial Officer
Email: dfarlett@afcurgentcare.com

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

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

Proficiency of Language Assistance Services

ATTENTION (English): If you do not speak English, we are able to provide you language assistance services, free of charge. Please contact:

Name: Jack Fromm

Email: jfromm@afcurgentcare.com

ATENCIÓN (Spanish): Si no habla inglés, podemos brindarle servicios de asistencia lingüística de forma gratuita. Póngase en contacto con:

Nombre: Jack Fromm

Correo electrónico: jfromm@afcurgentcare.com

*(Arabic)

ATTENTION :

انتباه:

If you do not speak English, we are able to provide you language assistance services, free of charge. Please contact:

إذا كنت لا تتحدث الإنجليزية، فيمكننا أن نقدم لك خدمات المساعدة اللغوية مجانًا. يرجى الاتصال بـ

Name: Jack Fromm

اسم: Jack Fromm

Email: jfromm@afcurgentcare.com

بريد إلكتروني: jfromm@afcurgentcare.com

注意（Chinese)： 如果您不会说英语，我们可以免费为您提供语言协助服务。请联系：

名字: Jack Fromm

电 邮: jfromm@afcurgentcare.com

CHÚ Ý (Vietnamese): Nếu bạn không nói được tiếng Anh, chúng tôi có thể cung cấp cho bạn các dịch vụ hỗ trợ ngôn ngữ miễn phí. Vui lòng liên hệ:

Tên: Jack Fromm

địa chỉ email: jfromm@afcurgentcare.com

주의(Korean): 영어를 구사하지 못하는 경우 언어 지원 서비스를 무료로 제공할 수 있습니다. 다음 연락처로 연락해 주십시오.

이름: Jack Fromm

이메일: jfromm@afcurgentcare.com

ATTENTION (French): Si vous ne parlez pas anglais, nous sommes en mesure de vous fournir des services d’assistance linguistique, gratuitement. Veuillez contacter:

nom: Jack Fromm

e-mail: jfromm@afcurgentcare.com

ຄວາມສົນໃຈ (Lao): ຖ້າທ່ານ່˚ບເວົ້າພາສາອັງກິດ,
ພວກເຮົາສາມາດໃຫ້ການ˚ບລິການຊ່ວຍເຫຼື ອທາງດ້ານພາສາໃຫ້ທ່ານໂດຍ່˚ບຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍ. ກະລຸນາຕິດຕ່˚ :

ຊ່ຼື: Jack Fromm

ອີເມວ: jfromm@afcurgentcare.com

ተውሳክ (Amharic) ፦ እንግሊዝኛ ካልተናገርክ በነጻ የቋንቋ እርዳታ አገልግሎት መስጠት እንችላለን። እባክዎን ያነጋግሩ፦

ስም: Jack Fromm

ኢሜይል: jfromm@afcurgentcare.com

BEACHTUNG (German): Wenn Sie kein Englisch sprechen, können wir Ihnen kostenlos Sprachunterstützung anbieten. Bitte kontaktieren Sie:

Name: Jack Fromm
E-Mail: jfromm@afcurgentcare.com

એટેન્શન (Gujarati) : જો તમે અંગ્રેજી ન બોલતા હો, તો અમે તમને વિનામૂલ્યે ભાષાસહકાર સેિાઓ પૂરી પાડી શકીએ છીએ. મહેરબાની કરીને સંપકક કરો:

નામ: Jack Fromm

ઇમેઇલ: jfromm@afcurgentcare.com

注意 (Japanese): 英語が話せない場合でも、無料で言語支援サービスを提供できます。下記までご連絡ください。

名前: Jack Fromm

メール: jfromm@afcurgentcare.com

ध्यान (Hindi): यदि आप अंग्रेज़ी नहkं बोलते हैं, तो हम आपको ननिःशुल्क भाषा सहायता सेवाएँ प्रिान करने में सक्षम हैं। कृपया संपकक करें:

नाम: Jack Fromm

ईमेल: jfromm@afcurgentcare.com

ВНИМАНИЕ (Russian): Если вы не говорите по-английски, мы можем
предоставить вам услуги языковой помощи бесплатно. Пожалуйста, обращайтесь:

имя: Jack Fromm
электронная почта: jfromm@afcurgentcare.com

*(Persian):

ATTENTION

توجه

If you do not speak English, we are able to provide you language assistance services, free of charge. Please contact:

اگر انگليسی بلد نيستيد، ما می توانيم خدمات کمک زبان را به صورت رايگان به شما ارائه دهيم. لطفا تماس بگيريد

Name: Jack Fromm

نام: Jack Fromm

شماره تلفن: ٢ ٣ ٤ ٧ ٦ ٥ ٩ ٩ ٠

Email: jfromm@afcurgentcare.com

ايميل: jfromm@afcurgentcare.com