Non Discrimination Notice at Urgent Care & Walk-in Clinic in Cleveland, TN
Notice and Non-Discrimination Statement
AFC Urgent Care/Family Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AFC Urgent Care/Family Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AFC Urgent Care/Family Care:
- 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
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreter services
- Information written in other languages
If you need these services, please notify clinic staff.
If you believe that AFC Urgent Care/Family Care 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:
Jack Fromm, Compliance Officer
1025 Peerless Crossing NW
Cleveland, TN 37312
423.476.5990 (p)
423.476.5887 (f)
jfromm@afcurgentcare.com
You can file a grievance in person or by mail, fax, or email. If you need help filing grievances contact: David Farlett, Chief Financial Officer.
David Farlett, Chief Financial Officer
1025 Peerless Crossing NW
Cleveland, TN 37312
423.476.5990 (p)
423.476.5887 (f)
dfarlett@afcurgentcare.com
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.
Proficiency of Language Assistance Services
ATTENTION (English): If you do not speak English, we are able to provide you language assistance services, free of charge. Please contact:
Name: Jack Fromm
Phone Number: 423.476.5990
Email: jfromm@afcurgentcare.com
ATENCIÓN (Spanish): Si no habla inglés, podemos brindarle servicios de asistencia lingüística de forma gratuita. Póngase en contacto con:
Nombre: Jack Fromm
Número de teléfono: 423.476.5990
Correo electrónico: jfromm@afcurgentcare.com
:إذا كنت لا تتحدث الإنجليزية، فيمكننا أن نقدم لك خدمات المساعدة اللغوية مجانًا. يرجى الاتصال بـ :(Arabic) انتباه
Jack Fromm :اسم
(٢ ٣ ٤ ٧ ٦ ٥ ٩ ٩ ٠) 423.476.5990 :رقم التليفون
jfromm@afcurgentcare.com :ريد إلكتروني
注意（Chinese)：如果您不会说英语，我们可以免费为您提供语言协助服务。请联系：
名字: Jack Fromm
电话号码: 423.476.5990 (四二三四七六五九九空)
电 邮: jfromm@afcurgentcare.com
CHÚ Ý (Vietnamese): Nếu bạn không nói được tiếng Anh, chúng tôi có thể cung cấp cho bạn các dịch vụ hỗ trợ ngôn ngữ miễn phí. Vui lòng liên hệ:
Tên: Jack Fromm
Số điện thoại: 423.476.5990 (四二三四七六五九九空)
địa chỉ email: jfromm@afcurgentcare.com
주의 (Korean): 영어를 구사하지 못하는 경우 언어 지원 서비스를 무료로 제공할 수 있습니다. 다음 연락처로 연락해 주십시오.
이름: Jack Fromm
전화 번호: 423.476.5990 (사이삼사칠육오구구영)
이메일: jfromm@afcurgentcare.com
ATTENTION (French): Si vous ne parlez pas anglais, nous sommes en mesure de vous fournir des services d’assistance linguistique, gratuitement. Veuillez contacter:
nom: Jack Fromm
numéro de téléphone: 423.476.5990
e-mail: jfromm@afcurgentcare.com
ຄວາມສົນໃຈ (Lao): ຖ້າທ່ານບໍ່ເວົ້າພາສາອັງກິດ, ພວກເຮົາສາມາດໃຫ້ການບໍລິການຊ່ວຍເຫຼືອທາງດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍ. ກະລຸນາຕິດຕໍ່:
ຊື່: Jack Fromm
ເບີໂທລະສັບ: 423.476.5990 (໔໒໓໔໗໖໕໙໙໐)
ອີເມວ: jfromm@afcurgentcare.com
ተውሳክ (Amharic) ፦ እንግሊዝኛ ካልተናገርክ በነጻ የቋንቋ እርዳታ አገልግሎት መስጠት እንችላለን። እባክዎን ያነጋግሩ፦
ስም: Jack Fromm
ስልክ ቁጥር: 423.476.5990 (፬፪፫፬፯፮፭፱፱ዜሮ)
ኢሜይል: jfromm@afcurgentcare.com
BEACHTUNG (German): Wenn Sie kein Englisch sprechen, können wir Ihnen kostenlos Sprachunterstützung anbieten. Bitte kontaktieren Sie:
Name: Jack Fromm
Telefonnummer: 423.476.5990
E-Mail: jfromm@afcurgentcare.com
એટેન્શન (Gujarati) : જો તમે અંગ્રેજી ન બોલતા હો, તો અમે તમને વિનામૂલ્યે ભાષાસહકાર સેવાઓ પૂરી પાડી શકીએ છીએ. મહેરબાની કરીને સંપર્ક કરો:
નામ: Jack Fromm
ફોન નંબર: 423.476.5990 (૪૨૩૪૭૬૫૯૯૦)
ઇમેઇલ: jfromm@afcurgentcare.com
注意 (Japanese): 英語が話せない場合でも、無料で言語支援サービスを提供できます。下記までご連絡ください。
名前: Jack Fromm
電話番号: 423.476.5990 (四二三四七六五九九空)
メール: jfromm@afcurgentcare.com
ध्यान (Hindi): यदि आप अंग्रेज़ी नहीं बोलते हैं, तो हम आपको निःशुल्क भाषा सहायता सेवाएँ प्रदान करने में सक्षम हैं। कृपया संपर्क करें:
नाम: Jack Fromm
फ़ोन नंबर: 423.476.5990 (૪૨૩૪૭૬૫૯૯૦)
ईमेल: jfromm@afcurgentcare.com
ВНИМАНИЕ (Russian): Если вы не говорите по-английски, мы можем предоставить вам услуги языковой помощи бесплатно. Пожалуйста, обращайтесь:
имя: Jack Fromm
номер телефона: 423.476.5990
электронная почта: jfromm@afcurgentcare.com
:
اگر انگلیسی بلد نیستید، ما می توانیم خدمات کمک زبان را به صورت رایگان به شما ارائه دهیم. لطفا تماس بگیرید :(Persian) توجه
Jack Fromm :اسم
(٢ ٣ ٤ ٧ ٦ ٥ ٩ ٩ ٠) 423.476.5990 :رقم التليفون
jfromm@afcurgentcare.com :ريد إلكتروني