Notice Informing Individuals About Nondiscrimination

and Accessibility Requirements

Cedar Rapids Pain Associates complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color,

national origin, age, disability, or sex. Cedar Rapids Pain Associates does not exclude people or treat them differently because of

race, color, national origin, age, disability, or sex.

Cedar Rapids Pain Associates:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o 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:

o Qualified interpreters

o Information written in other languages

• If you need these services, contact Kelly Johnson

If you believe that Cedar Rapids Pain Associates 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: Kelly Johnson, 4205 Glass Road NE,

Cedar Rapids, IA 52402, 319-294-0094, Fax 319-294-0095, kelly@crpainfree.com. You can file a grievance in person or by mail,

fax, or email. If you need help filing a grievance, Kelly Johnson 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.

POS Reorder # IA1622882

Limited English Proficiency of Language Assistance Services

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-319-734-4404.

ATENCION: si habla espanol, tiene a su disposicion servicios gratuitos de asistencia linguistica. Llame al 1-319-734-4404.

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 1-319-734-4404

CHU Y: Nếu bạn noi Tiếng Việt, co cac dịch vụ hỗ trợ ngon ngữ miễn phi danh cho bạn. Gọi số 1-319-734-4404.

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-319-734-4404.

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfugung. Rufnummer: 1-319-734-4404.

.319-734-4404- ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1

1-319-734-4404.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-319-734-4404 번으로 전화해 주십시오.

1-319-734-4404

ATTENTION : Si vous parlez francais, des services d’aide linguistique vous sont proposes gratuitement. Appelez le 1-319-734-4404.

Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-319-734-4404.

เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-319-734-4404.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-319-734-4404.

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ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-319-734-4404.