Notice of Nondiscrimination Statement: Hmong
Discrimination is Against the Law
Mountain View Family Dentistry 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. Mountain
View Family Dentistry 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.
Mountain View Family Dentistry:
• 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 Melissa Griffin, Civil Rights Coordinator.
Yog koj ntseeg hais tias Mountain View Family Dentistry 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: , Melissa Griffin,
Civil Rights Coordinator, 3055 NC 127 S Hickory, NC 28602, (phone) 1-828- 294-1362, (fax) 1-828- 294-
1874, (email) mgriffin@mtviewfamilydentistry.com. 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, Melissa
Griffin, 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.
