GASTROINTESTINAL HEALTHCARE AND ENDOSCOPY SUITE NOTICE OF NONDISCRIMINATION

GastroIntestinal Healthcare 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, gender
identification, age, disability/handicap, or limited English proficiency in certain health programs and activities.
Section 1557 and its implementing regulations may be examined in the office of Nancy Nicoll O’Neill, Civil
Rights Grievance Officer, 2011 Falls Valley Drive, Suite 106, phone: 919-870- 1311, fax: 919-881- 0822, email:
noneill@gihealthcare.net, who has been designated to coordinate the efforts of GastroIntestinal Healthcare to
comply with Section 1557.

GastroIntestinal Healthcare 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)

GastroIntestinal Healthcare provides free language services to people whose primary language is not English,
such as:

  • Qualified interpreters
  • Information written in other languages

Any person who believes someone has been subjected to discrimination on the basis of race, color, national
origin, sex, gender identification, age, disability/handicap, or limited English proficiency may file a grievance
under this procedure. It is against the law for GastroIntestinal Healthcare to retaliate against anyone who
opposes discrimination, files a grievance, or participates in the investigation of a grievance.
Procedure:

  • 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. This
    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 GastroIntestinal Healthcare 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 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 person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to
    the (Administrator/Chief Executive Officer/Board of Directors/etc.) within 15 days of receiving the
    Section 1557 Coordinator’s decision. The (Administrator/Chief Executive Officer/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, gender identification, age, disability/handicap, or limited English proficiency 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.

GastroIntestinal Healthcare will make appropriate arrangements to ensure that individuals with disabilities and
individuals with limited English proficiency are provided auxiliary aids and services or language assistance
services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are
not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low
vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible
for such arrangements.

Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al (888) 877-8353.

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 (919) 355-1673 (TTY:
(919) 355-1673).

Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí
dành cho bạn. Gọi số (888) 877-8353.

French Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.
Rele (888) 877-8353.

French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés
gratuitement. Appelez le (888) 877-8353.

Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (888) 877-
8353 번으로 전화해 주십시오.

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufnummer: (888) 877-8353.

Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza
linguistica gratuiti. Chiamare il numero (888) 877-8353.

Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги
перевода. Звоните (888) 877-8353.

Tagalog-Filipino: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng
tulong sa wika nang walang bayad. Tumawag sa (888) 877-8353.

Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń
pod numer (888) 877-8353.

Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue
para (888) 877-8353.

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。(888) 877-
8353.まで、お電話にてご連絡ください。

Hindi: ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। (888) 877-8353.पर
कॉल करें।

Punjabi: ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। (888) 877-
8353′ ਤੇ ਕਾਲ ਕਰੋ।