704-831-4400 • 1822 Brunswick Ave. • Charlotte, NC 28207
Carolina Center For Specialty Surgery complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Carolina Center For Specialty Surgery does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
Carolina Center For Specialty Surgery
o Provides free aids and services to people with disabilities to communicate effectively with us, such as:
o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
o Qualified interpreters
o Information written in other languages
If you need these services, contact the PACU Manager at 704-831-4420
If you believe that Carolina Center For Specialty Surgery has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, or sex, you can file a grievance with Brenda Page, Surgery Center Director, 1822 Brunswick Ave, Charlotte, NC 28207, 704-831-4410, fax 704-831-4411, firstname.lastname@example.org.
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Brenda Page, Director of Human Resources 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.
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©2014 Carolina Center For Specialty Surgery • All rights reserved