NOTICE OF NONDISCRIMINATION
Discrimination is Against the Law
ImmediaDent complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ImmediaDent does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
• 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 the Patient Services Specialist.
If you believe that ImmediaDent 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: Patient Services Specialist, 10601 Mission Road, Ste 240, Leawood, KS 66206 913-800-4685, 913-800-6960, firstname.lastname@example.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Patient Services Specialist 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, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
ImmediaDent’s Notice of Nondiscrimination is available in the top 15 languages of each state we practice in upon request. Please contact the Patient Services Specialist at 913-800-4685 or by email at email@example.com.