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Section 1557 of the Affordable Care Act Grievance

It is the policy of The Woodruff Institute for Dermatology & Cosmetic Surgery not to discriminate on the basis of race, color, national origin, sex, age or disability.

The Woodruff Institute 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:
Rachel Coughlin, 23471 Walden Center Drive, Suite 200, Bonita Springs, FL 34134, tel: (239) 498-3376 ext. 320, email: officemanager@thewoodruffinstitute.com, who has been designated to coordinate the efforts of The Woodruff Institute 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 The Woodruff Institute to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

• Rachel Coughlin, Practice Administrator and Section 1557 Coordinator, 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 The Woodruff Institute 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 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 Service
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. The Woodruff Institute 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.

Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Get Help in Other Languages

If you need help or speak a non-English language, call 1-800–368–1019 (TTY: 1-800-537-7697), and you will be connected to an interpreter who will assist you at no cost.

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

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

(cibarA) ال عرب ية
م لحوظة: إذا ك نت ت تحدث ال عرب ية، ف إن خدمات ال م ساعدة ال ل غوي ة ت تواف ر ل ك ب ال مجان.
ات صل ع لى ال رق م 9101 -368 (800) 7697-537 :مكبلاو مصلا فتاه) 1 (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。Call 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)
ت وجه: می ک ن يد، خدمات ي اری ر سان ی زب ان ی، ب طور اگ ر ب ه زب ان ف ار سی صح بت
راي گان، در د س ترس شما می
ب ا شد. 863 (008) ب ا شماره 1 -1019 ، )TTY: 1 )800( 537-7697 .دیریگب سامت (