NOTICE OF NON-DISCRIMINATION & GRIEVANCE PROCEDURE

Discrimination is Against the Law

Senta Clinic/San Diego Regional Head and Neck Center, Inc./Perry Mansfield MD, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Our office provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters; and Written information in other formats (large print, audio, accessible electronic formats). Our office provides free language services to people whose primary language is not English, such as: Qualified interpreters; and Information written in other languages.

If you need these services, contact Perry T. Mansfield, M.D. Inc.'s Clinic’s Civil Rights Coordinator: Lisa Sullivan. If you believe that Perry T. Mansfield, M.D. Inc. 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: Lisa Sullivan, 3590 Camino Del Rio North, Suite 100, San Diego, CA 92108, Phone: 619.810.1111, Fax: 619.229.4938, lsullivan@sentaclinic.com. You can file a grievance in person or by mail, fax, or email. 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.

Our office has adopted an internal grievance procedure providing 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 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Perry Mansfield, MD at 3590 Camino Del Rio North, Suite 100, San Diego, CA 92108, Phone: 619.810.1111, Fax: 619.229.4938. Any person 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 Senta Clinic/San Diego Regional Head and Neck Center, Inc./Perry Mansfield MD, Inc. to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

PROCEDURES:

• Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
• 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 Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint.
• The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than 30 days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.The investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of Senta Clinic/San Diego Regional Head and Neck Center, Inc./Perry Mansfield MD, Inc. relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the Board of Directors within 15 days of receiving the Section 1557 Coordinator’s decision. The Board of Directors/etc. shall issue a written decision in response to the appeal no later than 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, D.C. 20201

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination.