Notice Informing Individuals About Nondiscrimination and Accessibility

RequirementsInstitute Orthopaedic & Sports Medicine complies with applicable Federal civil rights laws and

does not discriminate on the basis of race, color, national origin, age, disability, or sex. Our practice does not exclude

people or treat them differently because of race, color, national origin, age, disability, or sex.Institute Orthopaedic &

Sports Medicine, provides at no cost 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 elec. formats,

other formats). Provides at no cost language services to people whose primary language is not English, such as: qualified

interpreters; information written in other languages. If you need these services please tell our front desk or any staff

member.If you believe our practice 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: Civil Rights Coordinator:

Charlynn Mercer, CPC,

8350 Riverwalk Park Boulevard, Suite 1 • Fort Myers, Florida 33919, 239-482-5399.

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance our Civil Rights Coordinator 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, 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

Proficiency of Language Assistance Services

ATTENTION: If you speak any of the languages below, language assistance services, free of charge, are available to you.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al. 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.CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho

bạn. Gọi số. 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 번으로 전화해

주십시오.PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang

bayad. Tumawag sa ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم رقم. :والبكم الصم ھ ATANSYON:

Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele. ВНИМАНИЕ: Если вы говорите на русском

языке, то вам доступны бесплатные услуги перевода. Звоните. ATTENTION : Si vous parlez français, des services d'aide

linguistique vous sont proposés gratuitement. Appelez le. UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy

językowej. Zadzwoń pod Numer. ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para.

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero.

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。 توجھ: اگر بھ زبان فارسی گفتگو می

کنید، تسھیلات زبانی بصورت رایگان برای شما .بگیرید تم ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche.