Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law

Northern Anesthesia Providers P.C. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age or sex. Northern Anesthesia Providers P.C. does not exclude people or treat them differently because of race, color, national origin, age disability or sex.

Northern Anesthesia Providers P.C. ;

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 please contact Northern Anesthesia Providers P.C.

If you believe that Northern Anesthesia Providers P.C. has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability or sex, you can file a grievance with: Nancy Boening (Office Manager) located at :602 Jackson St, Petoskey, MI 49770, Office number (231) 348-2795, Fax number (231) 348-2031, Email address nappc@sbcglobal.net . You can file a grievance in person or by mail, fax or email. If you need help filing a grievance Nancy Boening 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 of Civivl Rights Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone:

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