704-980-4301

Hmong (Hmoob)

Notice of Nondiscrimination Statement: Hmong

Discrimination is Against the Law

Piedmont Dental Associates ua raws cov kev cailij choj yuam siv ntawm Tsom Fwv Nrub Nrab

Teb Chaw hais txog pej xeem cov cai (Federal civil rights laws) thiab tsis ciav-cais leejtwg vim nws hom

neeg, nqaij tawv, lub tebchaws tuaj, hnub nyoog, kev tsis taus, los yog poj niam txiv. Piedmont Dental

Associates tsis cais cov neeg los yog coj ntxawv rau lawv vim haiv neeg, xim tawv nqaij, tuaj teb chaws

twg, hnub nyoog, kev tsis taus, los yog poj niam txiv.

Piedmont Dental Associates:

• Pab nyiaj thiab muab kev pab rau cov neeg txuas lus tsis taus zoo nrog peb, xws li:

○ Cov neeg txhais lus piav uas tsim nyog

○ Tej ntaub ntawv ua lwm hom (tu ntawv loj, suab lus, tej hom siv tau hauv electronic,

lwm lwm hom)

• Muab kev pab dawb txog lus hais rau cov neeg uas tsis hais lus Akiv, xws li:

○ Cov neeg txhais lus tsim nyog

○ Tej ntaub ntawv ua lwm hom lus

Yog koj xavtau cov kev pab no, thov hu rau Pattie Bumgarner, Civil Rights Coordinator.

Yog koj ntseeg hais tias Piedmont Dental Associates tsis muab tau cov kev pab no los yog tau coj

lwm hom kev ciav-cais saib raws haiv neeg, xim tawv nqaij, teb chaw tuaj, hnub nyoog, xiam oob qhab,

los poj niam lossis txiv neej, koj tuaj yeem xa ib daim ntawv tsis txaus siab nrog: , Pattie Bumgarner,

Civil Rights Coordinator, 181 W. Wilkes Med. Ctr. Rd. Ferguson, N.C. 28624, 1-336- 973-5060 (Phone),

1-336- 973-5150 (Fax), piedmontdental@gmail.com (Email). Koj xa daim ntawv tsis txaus siab kiag tus

kheej, raws kev xa ntawv, fev los yog email tuaj tau. Yog koj xav tau kev pab sau daim ntawv tsis txaus

siab, Pattie Bumgarner, Civil Rights Coordinator, pab tau koj.

Koj kuj muaj peev xwm ua tau ib daim ntawv tsis txaus siab rau cov cai pej xeem mus rau Mekas

Department of Health and Human Services (Thawj Fab Pab Kev Noj Qab Haus Huv thiab Pab Tib Neeg),

Office for Civil Rights (Chaw Ua Hauj Lwm txog Pej Xeem Cov Cai), tshuab hluav taws xob los ntawm

Office for Civil Rights Complaint Portal, nyob rau hauvhttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf, los

yog xa ntawv lossis hu xovtooj ntawm:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800- 868-1019, 800-537- 7697 (TDD)

Cov qauv ntawv tsis txaus siab muaj rau ntawmhttp://www.hhs.gov/ocr/office/file/index.html.