Notice of Nondiscrimination, Language and Disability Services

Discrimination is Against the Law

Northern Counties Health Care (NCHC) complies with applicable federal civil rights laws and does not discriminate, exclude people or treat them differently on the basis of race, color, national origin (including Limited English Proficiency and primary language), disability, age, religion or sex (including sex characteristics, pregnancy or related conditions, sexual orientation, gender identity, and sex stereotypes).

Language Assistance Services and Auxiliary Aids and Services

NCHC:

• Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language assistance services to people whose primary language is not English, which may include:
  • Qualified interpreters
  • Information written in other languages
    • See “I Speak” Language Identification Sheet

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, please contact the Practice Manager at the site where you receive care or your Home Health or Hospice contact OR NCHC’s Section 1557 Coordinator, Christel Mosher at christelm@nchcvt.org or 1-802-748-9405 x1206.

• Caledonia Home Health Care and Hospice: (802) 748-8116
• Concord Health Center: Ranson Hudson (802) 695-2512 x2029
• Danville Health Center: Ashley Leonard, RN (802) 684-2275 x6020
• Hardwick Area Health Center: Anna Keskula (802) 472-3300 x4121
• Island Pond Health and Dental Center: Kelley Leonard, RN (802) 723-4300 x3027
• Northern Counties Dental Center:  Melissa Moffatt (802) 472-2260 x5016
• Northern Express Care Newport: Ranson Hudson (802) 995-2412
• Northern Express Care St. Johnsbury: Lynne LaCourse, RN (802) 633-6351
• Orleans Dental Center: Jessica Simino (802) 754-6973 x7017
• Johnsbury Community Health Center: Nicole Haff, RN (802) 748-5041 x1217
• Section 1557 Coordinator: Christel Mosher, RN (802) 748-9405 x1206

Grievances

If you believe that NCHC 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 in person or by mail, fax, or email with Christel Mosher, Director of Quality and Compliance and Section 1557 Coordinator:

• Mail: Attn: Christel Mosher, Northern Counties Health Care, 165 Sherman Drive, St. Johnsbury, VT 05819
• Fax: (802) 748-4540
• E-mail: christelm@nchcvt.org
• Phone: (802)-748-9405 x1206

Process:

1. 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.
2. A grievance should generally be in writing, containing the name and contact information of the person filing it as well as the alleged discriminatory action and alleged basis (or bases) of discrimination, the date the grievance was filed, and any other pertinent information.
3. When a grievance includes allegations that would violate Section 1557, the Section 1557 Coordinator (or their designee) shall investigate the grievance. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the grievance.
4. NCHC shall inform an individual that they have a right to reasonable modifications in the grievance procedure if they need them.
5. The Section 1557 Coordinator must keep confidential the identity of an individual who has filed a grievance under this part except as required by law or to carry out the purposes of this part, including the conduct on any investigation, including to investigate the grievance.
6. NCHC will issue to the person who filed the grievance a written decision on the grievance no later than 30 days after its filing.
7. The decision shall include the resolution date and a notice to the complainant of their right to pursue further administrative or legal remedies.
8. NCHC will maintain the files and records relating to such grievances for at least three years from the date NCHC resolves the grievance.
9. The person filing the grievance may appeal the written decision by writing to the Chief Executive Officer within 15 days of receiving the decision.
10. The Chief Executive Officer shall issue a written decision in response to the appeal no later than 30 days after its filing.

If you need help filing a grievance, Christel Mosher, Director of Quality and Compliance is available to help you.

Complaints with Office of Civil Rights

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:

• Mail: U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building, Washington, D.C. 20201
• Phone: 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Notice of Availability of Language Assistance Services and Auxiliary Aids and Services in Other Languages

ATTENTION: If you speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-802-748-9405 or speak to your provider.

Arabic  (العربية)

تنبيه: إذا كنت تتحدث اللغة العربية، فستتوفر لك خدمات المساعدة اللغوية المجانية. كما تتوفر وسائل مساعدة وخدمات مناسبة لتوفير المعلومات بتنسيقات يمكن الوصول إليها مجانًا. اتصل على الرقم أو تحدث إلى مقدم        1-802-748-9405 الخدمة.

Bosnian (Bosanski): PAŽNJA: Ako govorite bosanski, dostupne su vam besplatne jezičke usluge. Odgovarajuća pomagala i usluge za pružanje informacija u pristupačnim formatima takođe se pružaju besplatno. Pozovite 1-802-748-9405 ili kontaktirajte svog pružatelja usluga.

Simplified Chinese (中文)^: 注意：如果您说[中文]，我们将免费为您提供语言协助服务。我们还免费提供适当的辅助工具和服务，以无障碍格式提供信息。致电 1-802-748-9405或咨询您的服务提供商。

French (Français): ATTENTION: Si vous parlez Français, des services d’assistance linguistique gratuits sont à votre disposition. Des aides et services auxiliaires appropriés pour fournir des informations dans des formats accessibles sont également disponibles gratuitement. Appelez le 1-802-748-9405 ou parlez à votre fournisseur.

German (Deutsch):  ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenzdienste zur Verfügung. Entsprechende Hilfsmittel und Dienste zur Bereitstellung von Informationen in barrierefreien Formaten stehen ebenfalls kostenlos zur Verfügung. Rufen Sie 1-802-748-9405 an oder sprechen Sie mit Ihrem Provider.

Japanese (日本語):  注：日本語を話される場合、無料の言語支援サービスをご利用いただけます。アクセシブル（誰もが利用できるよう配慮された）な形式で情報を提供するための適切な補助支援やサービスも無料でご利用いただけます。1-802-748-9405までお電話ください。または、ご利用の事業者にご相談ください。

Korean (한국어): 주의: [한국어]를 사용하시는 경우 무료 언어 지원 서비스를 이용하실 수 있습니다. 이용 가능한 형식으로 정보를 제공하는 적절한 보조 기구 및 서비스도 무료로 제공됩니다. 1-802-748-9405번으로 전화하거나 서비스 제공업체에 문의하십시오.

Nepali (नेपाली): सावधान: यदि तपाईं नेपाली भाषा बोल्नुहुन्छ भने तपाईंका लागि नि:शुल्क भाषिक सहायता सेवाहरू उपलब्ध छन्। पहुँचयोग्य ढाँचाहरूमा जानकारी प्रदान गर्न उपयुक्त सहायता र सेवाहरू पनि निःशुल्क उपलब्ध छन्।  1-802-748-9405 मा फोन गर्नुहोस् वा आफ्नो प्रदायकसँग कुरा गर्नुहोस्।

Russian (РУССКИЙ):  ВНИМАНИЕ: Если вы говорите на русский, вам доступны бесплатные услуги языковой поддержки. Соответствующие вспомогательные средства и услуги по предоставлению информации в доступных форматах также предоставляются бесплатно. Позвоните по телефону 1-802-748-9405 или обратитесь к своему поставщику услуг.

Somali (Soomaali):  FIIRO GAAR AH: Haddaad ku hadasho Soomaali, adeegyo kaalmada luuqadda ah oo bilaash ah ayaad heli kartaa. Qalab caawinaad iyo adeegyo oo habboon si loogu bixiyo macluumaadka qaabab la adeegsan karo ayaa sidoo kale bilaa lacag heli karaa. Wac 1-802-748-9405 ama la hadal bixiyahaaga.

Spanish (Español): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. También están disponibles de forma gratuita ayuda y servicios auxiliares apropiados para proporcionar información en formatos accesibles. Llame al 1-802-748-9405 o hable con su proveedor.

Swahili (Kiswahili): MAKINIKA: Ikiwa wewe huzungumza Kiswahili, msaada na huduma za lugha bila malipo unapatikana kwako. Vifaa vya usaidizi vinavyofaa na huduma bila malipo ili kutoa taarifa katika mifumo inayofikiwa pia inapatikana bila malipo. Piga simu 1-802-748-9405 au zungumza na mtoa huduma wako.

Thai (ไทย): หมายเหตุ: หากคุณใช้ภาษา ไทย เรามีบริการความช่วยเหลือด้านภาษาฟรี  นอกจากนี้ ยังมีเครื่องมือและบริการช่วยเหลือเพื่อให้ข้อมูลในรูปแบบที่เข้าถึงได้โดยไม่เสียค่าใช้จ่าย โปรดโทรติดต่อ 1-802-748-9405 หรือปรึกษาผู้ให้บริการของคุณ

Ukrainian (українська мова): УВАГА: Якщо ви розмовляєте українська мова, вам доступні безкоштовні мовні послуги. Відповідні допоміжні засоби та послуги для надання інформації у доступних форматах також доступні безкоштовно. Зателефонуйте за номером 1-802-748-9405 або зверніться до свого постачальника».

Vietnamese (Tiếng Việt): LƯU Ý: Nếu bạn nói tiếng Việt, chúng tôi cung cấp miễn phí các dịch vụ hỗ trợ ngôn ngữ. Các hỗ trợ dịch vụ phù hợp để cung cấp thông tin theo các định dạng dễ tiếp cận cũng được cung cấp miễn phí. Vui lòng gọi theo số 1-802-748-9405 hoặc trao đổi với người cung cấp dịch vụ của bạn.

Download a Copy of This Notice

• Notice of Nondiscrimination and Accessibility Requirements and Availability of Language Assistance Services and Auxiliary Aids and Services