Appendix A to Part 92—Notice Informing Individuals About Nondiscrimination and Accessibility
Requirements and Nondiscrimination Statement:
Discrimination is Against the Law

Spine Institute of Idaho complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Spine Institute of Idaho does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Spine Institute of Idaho:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
• Provides free language services to people whose primary language is not English, such as:

If you need these services, contact any of the Spine Institute of Idaho Receptionists or Shelby Stephens, Clinic Supervisor

If you believe that Spine Institute of Idaho 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: Shelby Stephens, Clinic Supervisor, 360 E. Montvue Dr. Ste 100 Meridian, ID 83642, Phone: 208-855-2900 Fax: 208-898-9877. You can file a grievance in person or by mail, or fax. If you need help filing a grievance, Shelby Stephens, Clinic Supervisor 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—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-208-855-2900.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-208-855-2900 (TTY: 1-208-855-2900).

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 1-208-855-2900（TTY：1-208-855-2900）。 OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-208-855-2900 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-208-855-2900).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-208-855-2900 (TTY: 1-208-855-2900).

번으로 전화해 주십시오. 
ध्यानाकर्षण: तपाईं [सम्मिलित भाषा], भाषा सहायता सेवाहरू, नि: शुल्क कुरा भने, उपलब्ध छन्। 1-208-855-2900 (: 1-208-855-2900).

टिटिवाइ) कल। ।CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-208-855-2900 (TTY: 1-208-855-2900).

تنبيه: إذا كنت تتحدث اللغة [إدراج]، خدمات المساعدة اللغوية، مجانا، تتوفر لك. دعوة 1-208-855-2900 (TTY: 1-208-855-2900).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-208-855-2900 (TTY: 1-208-855-2900).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-208-855-2900 (TTY: 1-208-855-2900).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-208-855-2900 (телетайп: 1-208-855-2900).

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-208-855-2900 (ATS : 1-208-855-2900).

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。1-208-855-2900（TTY: 1-208-855-2900）まで、お電話にてご連絡ください。 ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-208-855-2900 (TTY: 1-208-855-2900).

ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-208-855-2900 (TTY: 1-208-855-2900).

توجه: اگر شما [زبان درج]، خدمات کمک زبان، رایگان صحبت می کنند، در دسترس شما هستند. پاسخ 1-208-855-2900 (TTY: 1-208-855-2900).