Notice of Nondiscrimination and Grievance Procedure

Notice of Nondiscrimination
Grievance Procedure

Notice of Nondiscrimination

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

Patient First

  • 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 reasonably requested by persons with disabilities
  • Provides free language services to people whose primary language is not English, such as qualified interpreters provided in real time.

If you need these services, contact Harold Han, Civil Rights Compliance Coordinator.

If you believe that Patient First 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:

Harold Han, Civil Rights Compliance Coordinator,
Patient First
5000 Cox Road, Glen Allen, VA 23060
Tele: (804) 822-4375, Fax: (804) 968-5730
harold.han@patientfirst.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance Mr. Han 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.

Language Assistance Services

Free language assistance services are available to patients. During registration please ask front office staff for an interpreter.

If you have limited English proficiency, please see the information below that has been translated into your language about the availability of free language assistance services and how to access them.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Durante su registro, por favor, decirle al personal que necesita un intérprete.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 등록시, 통역이 필요로하는 직원을 알려주세요.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Trong thời gian đăng ký của bạn, xin vui lòng báo cho nhân viên mà bạn cần một thông dịch viên.

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。在您的注册,请告诉工作人员你需要一个解释。

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.

أثناء التسجيل، من فضلك قل الموظفين التي تحتاج إلى مترجم.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Sa panahon ng iyong pagpaparehistro, mangyaring sabihin sa tungkod, na kailangan mo ng isang interpreter.

توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد.

در هنگام ثبت نام، لطفا با کارکنان بگویید که شما نیاز به یک interpreter.

ማስታወሻ: አማርኛ መናገር ከሆነ, ነጻ የቋንቋ እርዳታ አገልግሎቶች ይገኛሉ. የምዝገባ ወቅት, አስተርጓሚ የሚፈልጉ መሆኑን ሰራተኞች ንገራቸው.

آپ اردو بولتے ہیں تو، مفت زبان کی مدد کی خدمات آپ کے لئے دستیاب ہیں. آپ کی رجسٹریشن کے دوران، براہ مہربانی، آپ کو مترجم کی ضرورت ہے کہ عملے کو مطلع

ATTENTION : Si vous parlez français, les services d'assistance linguistique sont disponibles gratuitement pour vous. Lors de votre inscription, s'il vous plaît informer le personnel que vous avez besoin d'un interprète.

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Во время регистрации, пожалуйста, сообщите об этом персоналу, что вам нужен переводчик.

ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। अपना पंजीकरण के दौरान, कृपया स्टाफ है कि आप एक दुभाषिए की जरूरत बताओ।

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Während Ihrer Anmeldung, bitte sagen Sie das Personal, dass Sie einen Dolmetscher benötigen.

লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। আপনার নিবন্ধনের সময়, একজন দোভাষীর জন্য জিজ্ঞাসা করুন.

AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. Nigba ìforúkọsílẹ, jọwọ beere fun ogbufọ kan.

Section 1557 of the Affordable Care Act Grievance Procedure

It is the policy of Patient First not to discriminate against patients on the basis of race, color, national origin, sex, age or disability. Patient First has adopted an internal grievance procedure for patients that provides 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 against patients on the basis of race, color, national origin, sex, age or disability in certain health programs and activities.

Any patient 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 Patient First to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

GRIEVANCE PROCEDURE:
  • Complaints regarding clinical services and other patient service issues, front office procedures, billing and other financial issues, and insurance coverage, must be directed to the Patient First Administrative Services Department at:

    Administrative Services
    Patient First
    5000 Cox Road
    Glen Allen, VA 23060
    Tel: (804) 968-5700
    Fax: (804) 968-5725
    Email: admin.offices@patientfirst.com

  • Complaints regarding the privacy and security of protected health information must be directed to the Patient First Privacy Officer at:

    Privacy Officer
    Patient First
    5000 Cox Road
    Glen Allen, VA 23060
    Tel: (804) 968-5700

    Information regarding Patient First’s privacy practices is available online at www.patientfirst.com.

  • Grievances regarding discrimination prohibited by Section 1557 must be submitted to the Patient First Administrative Services Department (contact info listed above) within sixty (60) days of the date the person filing the grievance becomes aware of the alleged discriminatory action. The Patient First Administrative Services Department shall contact the Civil Rights Compliance Coordinator (the “Coordinator”).

  • 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.

  • The Coordinator (or her/his designee) shall conduct an investigation of the complaint. Complaints involving both alleged discrimination and other concerns will be directed to the Patient First Administrative Services Department for investigation,

  • The Coordinator will maintain records regarding Patient First’s review, investigation and resolution of grievances under Section 1557. To the extent possible, the Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to Section 1557 grievances and will share them only with those who have a need to know.

  • The Coordinator or his designee will issue a written decision on the grievance no later than thirty (30) days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies; provided, that Patient First reserves the right to extend any investigation for such period of time as may reasonably be required to afford a full and fair review of any Section 1557 grievance.

  • The person filing the grievance may appeal the decision of the Coordinator by writing to General Counsel, 5000 Cox Road, Glen Allen, Virginia 23060, within fifteen (15) days of receiving the Coordinator’s decision. The General Counsel shall issue a written decision in response to the appeal no later than thirty (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

Such complaints must be filed within one hundred eighty (180) days of the date of the alleged discrimination.


October, 2016