Nondiscrimination and Accessibility Notice
Good Samaritan Medical Practice Association Nondiscrimination Notice
Good Samaritan Medical Practice Association complies with applicable Federal civil rights laws and do not discriminate on the basis of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression. Good Samaritan Medical Practice Association does not exclude people or treat them differently because of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression.
Good Samaritan Medical Practice Association:
- Provide free auxiliary aids and services to people with disabilities to communicate effectively with us, such as:
- qualified sign language interpreters, video remote interpreting or other aids for hearing impaired individuals
- written information in multiple formats including large print, audio, accessible electronic formats, or other formats for visually impaired individuals
- Provide free language services to people whose primary language is not English, such as:
- qualified interpreters or a language line
- information written in other languages
If you need these services, contact Good Samaritan Medical Practice Association at (562) 602-1563.
If you believe that Good Samaritan Medical Practice Association 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:
Compliance and Audit Manager
Mailing Address: 10833 Valley View Street, Suite 300, Cypress, CA 90630
Telephone: (562) 602-1563 Ext. 263
You can file a grievance in person or by mail or email. If you need help filing a grievance, Good Samaritan Medical Practice Association Compliance and Audit Manager 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
Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (562) 602-1563.
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562-602-1563 .
Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 562-602-1563 .
Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 562-602-1563 .
Korean: 주의: 한국어를 사용하시는경우, 언어지원 서비스를무료로 이용하실수 있습니다. 562-602-1563 번으로 전화해주십시오.
Armenian: ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝Եթե խոսումեք հայերեն, ապա ձեզանվճար կարողեն տրամադրվելլեզվական աջակցության ծառայություններ: Զանգահարեք 562-602-1563 :
Farsi: اب .دشابیممهارفامشیاربناگیارتروصبینابزتالیهست،دینکیموگتفگیسرافنابزهبرگا :هجوت.دیریگبسامت 562-602-1563 .دیریگبسامت
Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 562-602-1563 .
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。562-602-1563 まで、お電話にてご連絡ください。
Arabic: 562-602-1563 مقربلصتا .ناجملابكلرفاوتتةيوغللاةدعاسملاتامدخنإف،ةغللاركذاثدحتتتنكاذإ :ةظوحلم .
Punjabi: ਿਧਆਨਿਦਓ: ਜੇਤੁਸ ਪੰਜਾਬੀਬੋਲਦੇ ਹੋ, ਤ ਭਾਸ਼ਾਿਵੱ ਚ ਸਹਾਇਤਾਸੇਵਾ ਤੁਹਾਡੇਲਈ ਮੁਫਤਉਪਲਬਧ ਹੈ। 562-602-1563 ‘ਤੇਕਾਲ ਕਰੋ।
Cambodian: ្របយ័ត៖េបើសិនអកន ិ�យែខ , េស ជំនួយែ ផ�ក� េយមិន គិត ឈ ល គឺ ចនស ំប់បំេរ អ�ក ។ចូ រ ទូ រស័ ព 562-602-1563 ។
Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hurau 562-602-1563 .
Hindi: ध्यानद: यदआप हदं बोलते हतो आपके लए मुफ्तम भाषासहाय ता सेवाएंउपलब् ह। 562-602-1563 पर कॉलकर�।
Thai: เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรีโทร 562-602-1563 .