NONDISCRIMINATORY POLICY

Boling Vision Center and Insight Surgery Center has agreed to comply with the provisions of the Federal Civil Rights Act of 1964 and all requirements imposed pursuant thereto to the end that no person shall, on the grounds of race, color, national origin, ancestry, age, sex, religious creed, or disability, be excluded from participation in, be denied benefits of, or otherwise be subject to discrimination in the provision of any care or service.”

CIVIL RIGHTS COMPLIANCE

Boling Vision Center and Insight Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Boling Vision Center and Insight Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

LANGUAGE ASSISTANCE

Boling Vision Center and Insight Surgery Center provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters
  • Written information if other formats can be requested and made readily available, other formats may include (large print, audio, accessible electronic formats, other formats)

Boling Vision Center and Insight Surgery Center 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, or you believe that we have 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:

Heather Van Galen, ABOC, COA, NCLEC

Director of Operations

Boling Vision Center, LLC

2746 Old US Hwy 20 W.

Elkhart, IN  46514

574-293-3545  office

574-522-0599  fax

[email protected]

 

Kim Brown, RN BSN, CASC

Director of Nursing

Insight Surgery Center/Elkhart Day Surgery, LLC

2746 Old US 20 West

Suite C

Elkhart, IN 46514

574-326-3027 phone

574-970-0115 fax

[email protected]

If you need help filing a grievance, our Heather Van Galen, Director of Operations or Kim Brown, Director of Nursing 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 as follows:

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

Boling Vision Center and Insight Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

NOTIFICATION OF ASSISTANCE SERVICES FOR INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY OF LANGUAGE

ATTENTION: If you speak a foreign language, assistance services are available to you, free of charge, at: 574-293-3545.

Specific translations for Notice of Nondiscrimination, Nondiscrimination and Taglines are available at: http://www.hhs.gov/civil-rights/for- individuals/section-1557/translated-resources/

 

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al: 1-574-293-3545

 

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: 1-574-293-3545

 

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-574-293-3545

 

LET OP: Als je een vreemde taal te spreken, hulp diensten voor u beschikbaar zijn, kosteloos, op: 1-574-293-3545

 

သတျိ ပဳရန္ – အကယ၍္ သင္သည္ ျမန္မာစကား ကုိ ေျပာပါက၊ ဘာသာစကား အကအူ ည၊ီ အခမ၊့ဲ သင့္အတကြ ္ စစီ ဥေ္ ဆာငရ္ ြကေ္ ပးပါမည။္

ဖနု း္ နပံ ါတ္: 1-574-293-3545


ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم : 1-574-293-3545)رقم

ھاتف الصم والبك1-574-293-3545

 

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.: 1-574-293-3545 번으로 전화해 주십시오.

 

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số : 1-574-293-3545

 

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le : 1-574-293-3545

 

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。1-574-293-3545 まで、お電話にてご連絡ください。

 

AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-574-293-3545

 

Pansin: Kung nagsasalita ka ng isang wikang banyaga, mga serbisyo ng tulong ay magagamit sa iyo, nang walang bayad, sa: 1-574-293-3545

 

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-574-293-3545

 

ਧਿਆਨ: 1-574-293-3545: ਜੇਕਰ ਤੁਹਾਡੇ ਕੋਲ ਇੱਕ ਵਿਦੇਸ਼ੀ ਭਾਸ਼ਾ ਬੋਲ, ਜੇ, ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਉਪਲੱਬਧ ਹੈ, ਮੁਫ਼ਤ, ‘ਤੇ ਹੁੰਦੇ ਹਨ

 

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。1-574-293-3545 まで、お電話にてご連絡ください

 

SECTION 1557 OF THE AFFORDABLE CARE ACT, GRIEVANCE PROCEDURE

It is the policy of Boling Vision Center and Insight Surgery Center not to discriminate on the basis of race, color, national origin, sex, age or disability. Boling Vision Center and Insight Surgery Center 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 CFR part 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. 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 Boling Vision Center and Insight Surgery Center to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

SUBMISSION OF GRIEVANCE

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.

INVESTIGATION

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 the Practice 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.

APPEAL

The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the (Chief Executive Officer) within 15 days of receiving the Section 1557 Coordinator’s decision. The (Chief Executive Officer) 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, DC 20201
1-800-868-1019; 1-800-537-7697 (TDD)

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.

ACCOMMODATIONS IN THE GRIEVANCE PROCESS

Boling Vision Center and Insight Surgery Center 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.