Nondiscrimination Notice

Audubon County Memorial Hospital & Clinics does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, disability, religion, sex, sexual orientation, or gender identity. Audubon County Memorial Hospital & 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.

We provide the following for free:

• • • Communication aids and services to people with disabilities, such as:
      Qualified sign language interpreters
      Written information in other formats

• • • 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 Audubon County Memorial Hospital & Clinics. If you believe that we have failed to provide these services or discriminated on the basis of race, color, national origin, age, disability, religion, sex, sexual orientation, or gender identity, you can file a grievance in person, by mail or by phone with:

• Melanie Larsen, Compliance Officer
  Audubon County Memorial Hospital & Clinics
  515 Pacific Avenue
  Audubon, Iowa 50025
  Phone: 712-563-5238
  Fax: 712-563-5277
  Email: compliance@acmhhosp.org

Administration is available to help you file a grievance. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically 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,
  1-800-537-7697 (TDD)
  Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Other Resources:

Nondiscrimination Accessibility Notice

HHS Section 1557 of the Patient Protection and Affordable Care Act

Arabic
ﻣﻠﺣوظﺔ:  إذا ﻛﻧت ﺗﺗﺣدث اذﻛر اﻟﻠﻐﺔ، ﻓﺈن ﺧدﻣﺎت اﻟﻣﺳﺎﻋدة اﻟﻠﻐوﯾﺔ ﺗﺗواﻓر ﻟك ﺑﺎﻟﻣﺟﺎن.ﻗ

Mandarin
注意：如果您使用繁體中文，您可以免費獲得語言援助服 務。

French
ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.

German
ACHTUNG:  Wenn  Sie   Deutsch   sprechen,   stehen   Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.

Danish
BEMÆRK: Hvis du taler engelsk, er der gratis assistancetjenester tilgængelige for dig.

Gujarati
ુચના:  જો  તમે  +ુજરાતી  બોલતા  હો,  તો  િન:2ુ3ક  ભાષા  સહાય  સેવાઓ તમારા માટ< ઉપલ?ધ છે.

Hindi
यान द: य)द आप ,हिदी बोलते ह तो आपके िलए मु;त म’ भाषा सहायता सेवाएं उपलAध ह।

Hmong
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj.

Italian
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.

Korean
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

Polish
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.

Russian
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

Spanish
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Tagalog
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.

Vietnamese
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.

English
ATTENTION: If you speak English language assistance services, free of charge, are available to you.