Nondiscriminatory/Civil Rights
Compliance Policy
Nondiscriminatory/Civil Rights Compliance Policy
Informing Individuals of Language Assistance Services
Language Assistance
ATx360 Physicians for Pain Management PLLC complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATx360 Physicians for Pain Management PLLC provides free aids and services to people with disabilities or with limited English proficiency to assist in communicating effectively with us. These services include:
• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, or otherformats)
• Qualified interpreters
• Information written in other languages
These services are made available by contacting the office administrator at (512) 734-8060.
If you believe that ATx360 Physicians for Pain Management PLLC 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, by mail, by fax, or over the phone:
ATx360 Physicians for Pain Management PLLC
7700 Cat Hollow Drive, Suite 203
Round Rock, TX 78681
Phone: (512) 734-8060
If you need help filing a grievance, the office administrator 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/smartscreen/main.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. 2021
1-800-368-1019
(TDD 1-800-537-7697)
Complaint forms are available at http://www.hhs.gov/ocr/filing-with-ocr/index.html
Informing Individuals with Limited English Proficiency of Language Assistance Services
Albanian
KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në
1-877-696-6775 (TTY: 1-800-537-7697).
Amharic
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-
877-696-6775 (መስማት ለተሳናቸው: 1-800-537-7697).
Arabic
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغ��ة تتوافر لك بالمجان. اتصل برقم -1 877-696-6775 (رقم هاتف الصم
والبكم: -1 800-537-7697).
Armenian
ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական
աջակցության ծառայություններ: Զանգահարեք 1-877-696-6775 (TTY (հեռատիպ)՝ 1-800-537-7697):
Assyrianܵ
ܙܘܗ : ܸܐܢ ܢ ܵ ܪ ܿ ܼܐ ܹܟܐ ܢ ܿ ܚܬܘ ܵ ܼܗ ܐ ܿ ܸܡܙ ܼܡܝܬܘ ܢ ܵ ܸܠܫ ܐ ܵ ܝ ܵ ܿ ܪ ܿ ܐ ، ܢ ܵ ܬܘ ܿ ܡ ܢ ܵ ܼܨܝܬܘ ܵ ܸܚ ܼܠܡ ܐ ܿ ܼܕܩ ܹܬܐ ܿ ܼܒܠܝܬܘ ܿܪܬ ܼܝ ܵ ܼܕܗ ܐ ܿ ܢ ܵ ܸܒܠܫ ܼܐܝܬ ܵ ܵ ܼܥ ܐ ܿ ܩܪܘ ܠ ܿ ܼܡ . ܢ ܿ ܓ ܵ ܢ ܵܢ ܸܡܢܝ
1-877-696-6775 (TTY: 1-800-537-7697)
Bassa
Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m̀ [Ɓàsɔɔ́ ̀-wùɖù-po-nyɔ̀] jǔ ní, nìí, à wuɖu kà kò ɖò po-poɔ̀ɓɛìn ́ m̀ gbo kpáa. Ɖá
1-877-696-6775 (TTY: 1-800-537-7697)
Bengali
ল�� ক�নঃ যিদ আপিন বাংলা, কথা বলেত পােরন, তাহেল িনঃখরচায় ভাষা সহায়তা পিরেষবা উপল� আেছ।
েফান ক�ন ১-877-696-6775 (TTY: ১-800-537-7697)।
Bisayan
ATENSYON: Kung nagsulti ka og Cebuano, aduna kay magamit nga mga serbisyo sa tabang sa lengguwahe, nga
walay bayad.Tawag sa 1-877-696-6775 (TTY: 1-800-537-7697).
Burmese
သတိ◌ျပဳရန္- အကယ္၍ သင�ည္◌ျမ��ာစကား ကိုေ◌◌ျပာပါက၊ ဘာသာစကား အကူအညီ၊ အခမဲ့
၊ သင္◌အ�တက္ ့ စီစဥ္ေ◌ဆာ�င�က္ေ◌ပးပါမည္။ ဖုန္◌းနံပါတ္1-877-696-6775 (TTY: 1-800-537-7697) သု◌ိ႔ ေ◌ခၚဆိုပါ။
Cambodian
្របយ័ត�៖ េបើសិនជោអ�កនិយោយ ភាសាែខ�រ, េសវោជំនួយែផ�កភាសា េដោយមិនគិតឈ��ល គឺឣចមានសំរោប់បំេរ�អ�ក។ ចូរ ទូរស័ព�
1-877-696-6775 (TTY: 1-800-537-7697)។
Catalan
ATENCIÓ: Si parleu Català, teniu disponible un servei d”ajuda lingüística sense cap càrrec.
Truqueu al 1-877-696-6775 (TTY o teletip: 1-800-537-7697).
Chamorro
ATENSIÓN: Yanggen un tungó [I linguahén Chamoru], i setbision linguahé gaige para hagu dibatde ha . Agang
I 1-877-696-6775 (TTY: 1-800-537-7697).
Cherokee
Hagsesda: iyuhno hyiwoniha [tsalagi gawonihisdi]. Call 1-877-696-6775 (TTY: 1-800-537-7697)
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 1-877-696-6775(TTY:1-800-537-7697)。
Choctaw
ANOMPA PA PISAH: [Chahta] makilla ish anompoli hokma, kvna hosh Nahollo Anompa ya pipilla hosh chi
tosholahinla. Atoko, hattak yvmma im anompoli chi bvnnakmvt, holhtina pa payah: 1-877-696-6775 (TTY: 1-800-537-7697).
Dinka
PIŊ KENE: Na ye jam në Thuɔŋjaŋ, ke kuɔny yenë kɔc waar thook atɔ̈kuka lëu yök abac ke cïn wënh cuatë piny.
Yuɔpë 1-877-696-6775 (TTY: 1-800-537-7697)
Dutch
AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-877-696-6775 (TTY: 1-800-537-7697).
English
ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you.
Call 1-877-696-6775 (TTY: 1-800-537-7697).
Farsi
: ا�ر به ز�ان فار� گفتگو � کن�د، �سه�لات ز�ای 1-800- :TTY (1-877-696-6775 ف توجه بصورت را�گان برای شما فراهم � باشد. با
(537-7697 ی تماس بگ��د.
French
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.
Appelez le 1-877-696-6775 (ATS : 1-800-537-7697).
Fulfulde
MAANDO: To a waawi [Adamawa], e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-877-696-6775 (TTY:
1-800-537-7697).
German
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung. Rufnummer: 1-877-696-6775 (TTY: 1-800-537-7697).
Greek
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες
παρέχονται δωρεάν. Καλέστε 1-877-696-6775 (TTY: 1-800-537-7697).
Gujarati
�ચના ુ : જો તમે�જરાતી ુ બોલતા હો, તો િન:�લ્કુ ભાષા સહાય સેવાઓ તમારા માટ�ઉપલબ્ધ છે. ફોન કરો 1-877-696-6775 (TTY: 1-800-537-7697).
Haitian-Creole
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-877-696-6775 (TTY: 1-800-537-7697).
Hawaiian
E NĀNĀ MAI: Inā hoʻopuka ʻoe i ka ʻōlelo [hoʻokomo ʻōlelo], loaʻa ke kōkua manuahi iā ʻoe. E kelepona iā 1-877-696-6775 (TTY: 1-800-537-7697).
Hindi
�ान द�: यिद आप िहंदी बोलतेह�तो आपकेिलए मु� म�भाषा सहायता सेवाएं उपल� ह�। 1-877-696-6775 (TTY: 1-800-537-7697) पर कॉल कर� ।
Hmong
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-877-696-6775 (TTY: 1-800-537-7697).
Ibo
Ige nti: O buru na asu Ibo asusu, enyemaka diri gi site na call 1-877-696-6775 (TTY: 1-800-537-7697).
Ilocano
PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan
para kenyam. Awagan ti 1-877-696-6775 (TTY: 1-800-537-7697).
Indonesian
PERHATIAN: Jika Anda berbicara dalam Bahasa Indonesia, layanan bantuan bahasa akan tersedia secara
gratis. Hubungi 1-877-696-6775 (TTY: 1-800-537-7697).
Italian
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.
Chiamare il numero 1-877-696-6775 (TTY: 1-800-537-7697).
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。1-877-696-6775(TTY: 1-
800-537-7697)まで、お電話にてご連絡ください。
Kirundi
ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-877-
696-6775 (TTY: 1-800-537-7697).
Korean
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-877-696-6775
(TTY: 1-800-537-7697) 번으로 전화해 주십시오.
Kurdish
ت ی زمان، بەخۆڕای ئا�اداری: ئەگەر بە زمائنکوردی ، بۆ تۆ بەردەستە. پەیوەندی بە ئن ن �ارمەی قەسە دەکە�ت، خزمەتگوزار�ەکای
پەیوەندی بە 877-696-6775 1- (1-800-537-7697) TTY بکە.
Lao
ໂປດຊາບ: ຖ້ າວ່ າ ທ່ ານເວົ ້ າພາສາ ລາວ, ການໍ ບິ ລການຊ່ ວຍເຫືຼ ອດ້ ານພາສາ, ໂດຍບໍ ່ ເສັ ຽຄ່ າ, ແມ່ ນມີ ພ້ ອມໃຫ້ທ່ ານ. ໂທຣ 1-877-696-6775 (TTY: 1-800-537-7697).
Marshallese
LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-877-
696-6775 (TTY: 1-800-537-7697).
Navajo
D77 baa ak0 n7n7zin: D77 saad bee y1n7[ti’go Diné Bizaad, saad bee 1k1’1n7da’1wo’d66’, t’11 jiik’eh, 47 n1
h0l=, koj8’ h0d77lnih 1-877-696-6775 (TTY: 1-800-537-7697.)
Nepali
�ान िदनुहोस्: तपाइ�लेनेपाली बोल्नु�न्छ भनेतपाइ�को िन�� भाषा सहायता सेवाह� िनः शु� �पमा उपल� छ । फोन
गनु�होस्1-877-696-6775 (िटिटवाइ: 1-800-537-7697) ।
Norwegian
MERK: Hvis du snakker norsk, er gratis språkassistansetjenester tilgjengelige for deg. Ring 1-877-696-6775
(TTY: 1-800-537-7697).
Oromo
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa
1-877-696-6775 (TTY: 1-800-537-7697).
Pennsylvania-Dutch
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass
dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-877-696-6775 (TTY: 1-800-537-7697).
Pohnpeian
Ni songen mwohmw ohte, komw pahn sohte anahne kawehwe mesen nting me koatoantoal kan ahpw wasa
me ntingie [Lokaiahn Pohnpei] komw kalangan oh ntingidieng ni lokaiahn Pohnpei.
Call 1-877-696-6775 (TTY: 1-800-537-7697).
Polish
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-
877-696-6775 (TTY: 1-800-537-7697).
Portuguese
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-877-696-
6775 (TTY: 1-800-537-7697).
Punjabi
ਿਧਆਨ ਿਦਓ: ਜੇਤੁਸ� ਪੰ ਜਾਬੀ ਬੋਲਦੇਹੋ, ਤ� ਭਾਸ਼ਾ ਿਵੱ ਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-877-696-6775 (TTY: 1-800-537-7697) ‘ਤੇਕਾਲ ਕਰੋ।
Romanian
ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-
877-696-6775 (TTY: 1-800-537-7697).
Russian
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните 1-877-696-6775 (телетайп: 1-800-537-7697).
Samoan
MO LOU SILAFIA: Afai e te tautala Gagana fa’a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi,
mo oe, Telefoni mai: 1-877-696-6775 (TTY: 1-800-537-7697).
Serbo-Croatian
OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-
877-696-6775 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-800-537-7697).
Spanish
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-
696-6775 (TTY: 1-800-537-7697).
Swahili
KUMBUKA: Ikiwa unazungumza Kiswahili, unaweza kupata, huduma za lugha, bila malipo. Piga simu 1-877-
696-6775 (TTY: 1-800-537-7697).
Tagalog
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang
walang bayad. Tumawag sa 1-877-696-6775 (TTY: 1-800-537-7697).
Telugu
�శద��ట�ం�: ఒక�ళ �� ��� �ష��� ��న�ట���, � �ర� ��� �� స�యక
�వ� ఉ�తం� ల����. 1-877-696-6775 (TTY: 1-800-537-7697) � �ల్ �యం�.
Thai
เรียน: ถ ้าคุณพูดภาษาไทยคุณสามารถใช ้บริการช ่วยเหลือทางภาษาได ้ฟรี โทร 1-877-696-6775 (TTY: 1-800-537-
7697).
Tongan
FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni
ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1-877-696-6775 (TTY: 1-800-537-7697).
Trukese
MEI AUCHEA: Ika iei foosun fonuomw: Foosun Chuuk, iwe en mei tongeni omw kopwe angei aninisin chiakku,
ese kamo. Kori 1-877-696-6775 (TTY: 1-800-537-7697).
Turkish
DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz. 1-877-
696-6775 (TTY: 1-800-537-7697) irtibat numaralarını arayın.
Ukrainian
УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби
мовної підтримки. Телефонуйте за номером 1-877-696-6775 (телетайп: 1-800-537-7697).
Urdu
بخ�دار: ا�ر آپ اردو بول� 1- :TTY (1-877-696-6775 ت ی ہن ی ، تو آپ کو ز�ان � مدد � خدمات مفت من ی دست�اب ہن ۔ کال ک��ں
800-537-7697).
Vietnamese
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-696-6775
(TTY: 1-800-537-7697).
Yiddish
1-877-696- אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. רופט
6775 (TTY: 1-800-537-7697)
Yoruba
AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-877-696-6775
(TTY: 1-800-537-7697).
Section 1557 of the Affordable Care Act Grievance Procedure
It is the policy of ATx360 Physicians for Pain Management PLLC not to discriminate on the basis of race, color, national origin, sex, age or disability. ATx360 Physicians for Pain Management PLLC 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 CFR part 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.
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 the Practice to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a
grievance.
Submission of Grievance
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.
Investigation
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 the Practice 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.
Appeal
The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the (Chief Executive Officer) within 15 days of receiving the Section 1557 Coordinator’s decision. The (ChiefExecutive Officer) 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, DC 20201
(800) 368-1019
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.
Accommodations in the Grievance Process
ATx360 Physicians for Pain Management PLLC 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.