Notice of Nondiscrimination

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

Indiana Eye Clinic 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, other formats)

Indiana Eye Clinic Provides free language services to people whose primary language is not English, such
as:

  • Qualified interpreters
  • Information written in other languages

If you need these services, contact our Language Service Line at 317-886-2886.

If you believe that Indiana Eye Clinic 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 by
contacting the Certified Patient Services Specialist at 317-886-2886. The Certified Patient Services
Specialist will provide information on how to file a grievance in person, by mail or fax.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office
of Civil Rights, electronically through the Office of 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.

Additional Languages

Español (Spanish)

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al
1-317-886-2886.

繁體中文 (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 1-317-886-2886.

Deutsch (German)

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.
Rufnummer: 1-317-886-2886.

Deitsch (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 1-317-886-2886.

العربية (Arabic)

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-317-886-2886
رقم

မြန်မာ (Burmese)

Burmese Text Translation

한국어 (Korean)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-317-886-2886 번으로 전화해 주십시오.

Tiếng Việt (Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-317-886-2886.

Français (French)

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez
le 1-317-886-2886.

日本語 (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。1-317-886-2886.

Nederlands (Dutch)

AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-317-886-2886.

Tagalog (Tagalog – Filipino)

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-317-886-2886.

Русский (Russian)

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-317-886-2886.

ਪੰਜਾਬੀ (Punjabi)

ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤ ਭਾਸ਼ਾ ਿਵੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-317-886-2886.

हिंदी (Hindi)

ध्यान द: यद आप हदी बोलते ह तो आपके िलए मुफ्त म भाषा सहायता सेवाएं उपलब्ध ह। 1-317-886-2886.