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Non-Discrimination Policy

Franklin General Hospital 
Section 1557 Non-Discrimination 

Notice Informing Individuals About Nondiscrimination and Accessibility
Requirements and Sample Nondiscrimination Statement:
Discrimination is Against the Law 

Franklin General Hospital welcomes all individuals who come to us for care, treatment, and services. We comply with all Federal civil right laws and do not exclude anyone or treat them differently because of their age, race, color, ethnicity (including limited English proficiency and primary language), national origin, religion, culture, language, physical or mental disability, socioeconomic status (including ability to pay or participation in Medicaid, Medicare, or Children's Health Insurance Program), sex (including sex at birth or legal sex), sex characteristics (including intersex traits), pregnancy or related conditions, sex stereotypes, sexual orientation, gender identity or expression, veteran status, or any other category protected by law.

 

Franklin General Hospital:

  • 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.

       

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact the FGH Compliance Officer.
 

If you believe that Franklin General Hospital 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:

 

FGH Compliance Officer, 1720 Central Ave. E., Hampton, IA 50441, 641-456-5004, 641-456-5049, chippj@mercyhealth.com.

 

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the FGH Compliance Officer 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.


Franklin General Hospital complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 

 

English  

ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-641-456-5039.

  
Español (Spanish)  

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-641-456-5039.

 

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 1-641-456-5039.

 

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 1-641-456-5039.


Srpsko-hrvatski (Serbo-Croatian)  

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-641-456-5039.


Deutsch (German) 

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-641-456-5039.


ةيبرعلا (Arabic)

) مقر  1-641-456-5039. : ةظوحلم تنك اذإ ركذا ثدحتت نإف ،ةغللا ةدعاسملا تامدخ رفاوتت ةیوغللا. ناجملاب كل مقرب لصتا .( 1-641-456-5039. :مكبلاو مصلا فتاھ

 

ພາສາລາວ (Lao, Laotian) 

ໂປດຊາບ: ຖ ້ າວ ່ າ ທ ່ ານເວ ົ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ ວຍເຫຼື ອດ້ ານພາສາ, ໂດຍບໍ່ ເສັ ຽຄ່ າ, ແມ ່ ນມ ີ ພ ້ ອມໃຫ ້ ທ ່ ານ. ໂທຣ 1-641-456-5039.

 

한한한 (Korean) 

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-641-456-5039. 번으로 전화해 주십시오. 

 

िहंदी (Hindi)  

ध्यान द�: य�द आप �हदी बोलते ह �तो आपके ि◌लए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह।� 1-641-456-5039. पर कॉल कर�। 


Français (French)   

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-641-456-5039.


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 1-641-456-5039.


ภาษาไทย (Thai)

เรียน: ถา้คุณพดูภาษาไทยคุณสามารถใชบ้ริการช่วยเหลือทางภาษาไดฟ้รี โทร 1-641-428-7000 1-641-456-5039.


Tagalog (Tagalog – Filipino)

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-641-456-5039.


unD (Karen)

LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 11-641-456-5039.


Русский (Russian) 

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-641-456-5039.