GulfCoast Spine Institute, Inc. dba BioSpine Institute complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. GulfCoast Spine Insitute, Inc. dba BioSpine Institute does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
GULFCOAST SPINE DBA BIOSPINE INSTITUTE
- 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: Chinese, French, German, Spanish, French Creole, Vietnamese, Portuguese, Tagalog, Russian, Arabic, Italian, Korean, Polish, Gujarati, and Thai.
- Qualified interpreters or information written in other languages.
Contact the BioSpine Civil Rights Coordinator Designee
If you need these services, contact the BioSpine Civil Rights Coordinator Designee.
If you believe that Gulfcoast Spine Institute, Inc. dba BioSpine Institute has failed to provide these services or discriminated in another way on race, color, national origin, age, disability, or sex, you can file a grievance with:
The BioSpine Civil Rights Coordinator Designee
4211 W. Boy Scout Blvd.
Suite 400 | Tampa, FL 33607
(813) 773-0800 ext. #506 Fax # (813) 443-8255
CivilRights@Biospine.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the BioSpine Civil Rights Coordinator Designee is available to help you or 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. 2001
1-800-368-1019
800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
ATTENTION
If you speak one of the following languages, assitance is available to you free of charge. Please ask for
assistance from a staff member.
Español (Spanish)
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia
lingüística. Llame al 1-877-696-6775.
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 1-877-696-6775。
Tiếng Việt (Vietnamese)
CHÚ †: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
Gọi số 1-877-696-6775.
한국어 (Korean)
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1-877-696-6775 번으로 전화해 주십시오.
Русский (Russian)
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные
услуги перевода. Звоните 1-877-696-6775. Washington, D.C. 20201
ةيبرعلا†®Arabic©
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Kreyòl Ayisyen (Haitian Creole)
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.
Rele 1-877-696-6775.
Français (French)
ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés
gratuitement. Appelez le 1-877-696-6775.
Polski (Polish)
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.
Zadzwoń pod numer 1-877-696-6775.
Português (Portuguese)
Se necessita destes serviços, contacte HHS através do número 1-877-696-6775.
Italiano (Italian)
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza
linguistica.
Deutsch (German)
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen
zur Verfügung. Rufnummer: 1-877-696-6775.
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。1-877-696-
6775 まで、お電話にてご連絡ください。
یسراف†®Farsi©
1≠877≠696≠†Æ†اب†Æدشاب†یم†مهارف†امش†یارب†ناگیار†تروصب†ینابز†تالیهست†،دینک†یم†وگتفگ†یسراف†نابز†هب†رگا†∫هجوت
تیلصا†،تسوپ†گنر†،داژن†ساسا†رب†یضیعبت†هنوگچیه†و
