Appendix A to Part 92—
Pediatric Specialist of Virginia (PSV) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. PSV does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Pediatric Specialists of Virginia 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)
• 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, contact one of our Practice Managers – Nora Washington (Hamaker) or Steve Saunders (All Other Clinics); or our Ambulatory Surgery Center Administrator, Chelsea Lee – Mail: 3023 Hamaker Court, Suite 200, Fairfax, VA 22031, Phone: 703.848.6610, [TTY number—1.800.828.1120], Fax: 703.839.8779, or Email: PSVCommunications@PSVCare.org.
If you believe that PSV 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: one of our Practice Managers – Nora Washington (Hamaker) or Steve Saunders (All Other Clinics); or our Ambulatory Surgery Center Administrator, Chelsea Lee via Mail: 3023 Hamaker Court, Suite 200, Fairfax, VA 22031, Phone: 703.848.6610, [TTY number—1.800.828.1120], Fax: 703.839.8779, or Email: PSVCommunications@PSVCare.org.
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, one of our Practice Managers – Nora Washington (Hamaker) or Steve Saunders (All Other Clinics); or our Ambulatory Surgery Center Administrator, Chelsea Lee 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.
Appendix B to Part 92—
Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-703-848-6610 (TTY: 1-800-855-8200).
한국어 (Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-703-848-6610 (TTY: 1-800-828-1120)번으로 전화해 주십시오.
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-703-848-6610 (TTY: 1-800-828-1120).
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 1-703-848-6610（TTY: 1-800-828-1120）。
العربية (Arabic): ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-703-848-6610 (رقم هاتف الصم والبكم: 1-1-1-800-828-1120).
Tagalog - Filipino: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-703-848-6610 (TTY: 1-800-828-1120).
فارسی (Farsi): توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با 1-703-848-6610 (TTY: 1-800-828-1120) تماس بگیرید.
አማርኛ (Amharic): ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-703-848-6610 (መስማት ለተሳናቸው: 1-800-828-1120).
اُردُو (Urdu): خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-703-848-6610 (TTY: 1-800-828-1120).
Français (French): ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-703-848-6610 (ATS : 1-800-828-1120).
Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-703-848-6610 (телетайп: 1-800-828-1120).
हिंदी (Hindi): ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-703-848-6610 (TTY: 1-800-828-1120) पर कॉल करें।
Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-703-848-6610 (TTY: 1-800-828-1120).
বাংলা (Bengali): লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। ফোন করুন ১-703-848-6610 (TTY: ১-800-828-1120)।
èdè Yorùbá (Yoruba): AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-703-848-6610 (TTY: 1-800-828-1120).