PURPOSE

To provide notice to patients/residents, employees, and others of the availability of programs and services of Mangum Hospital and Mangum Family Medical Clinic to all persons without regard to race, color, national origin, age, disability, sex, sexual orientation, gender identity, religion, or ability to pay.

SCOPE

Hospital facility and Rural Health Clinic

POLICY STATEMENT

As a recipient of Federal financial assistance, Mangum Hospital and Mangum Family Medical Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, and in staff and employee assignments to patients, whether carried out by this healthcare facility directly or through a contractor or any other entity with which it arranges to carry out its programs and activities.

This statement is in compliance with the provision of Title VI of the Civil Rights Act of 1964 (nondiscrimination onthe basis of race, color, national origin), Section 504 of the Rehabilitation Act of 1973 (nondiscrimination on the basis of disability), the Age Discrimination Act of 1975 (nondiscrimination on the basis of age), regulations of the U.S. Department of Health and Human Services issued pursuant to these three statutes at Title 45 Code of Federal Regulation Part 80, 84, and 91.

Additionally, in accordance with Section 1557 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 18116, this facility does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of sex (including gender identity) in admission to, participation in, or receipt of the services and benefits under any of its health programs and activities, and in staff and employee assignments, whether carried out by Mangum Hospital or the Rural Health Clinic directly or through a contractor or any other entity with which this healthcare facility arranges to carry out its programs and activities. Mangum Hospital and Mangum Family Medical Clinic do not discriminate inthe provision of services to an individual

if the individual is unable to pay or if payment would be made under Medicare, Medicaid, or the Children’s Health Insurance Plan.

This facility does not exclude people or treat them differently because of race, color, national origin, age, disability sex, sexual orientation, gender identity, religion, or ability to pay.

Mangum Hospital and Mangum Family Medical Clinic provide free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters; and

Written information in other formats (large print, audio, accessible electronic formats and other formats).

This facility provides free language services to people whose primary language is not English, such as:

• Qualified interpreters; and
• Information written in other

If you need these services, contact the Compliance Coordinator of Mangum Hospital and Mangum Family Medical Clinic.

If you believe that Mangum Hospital or Mangum Family Medical Clinic have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, religion, or ability to pay you can file a grievance with:

The Compliance Coordinator at Mangum Hospital

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the ComplianceCoordinator, is available to help you. You can also file a civil rights complaint with the U.S. Department of Health andHuman 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, DC 20201

1–800–868–1019, 800–537–7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Mangum Hospital and Mangum Family Medical Clinic cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad, sexo, orientacion sexual, identidad de genero,religion, o habilidad para pagar.

Mangum Hospital and Mangum Family Medical Clinic no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.

Mangum Hospital and Mangum Family Medical Clinic proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes:

• Intérpretes de lenguaje de señas
• Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).

Mangum Hospital and Mangum Family Medical Clinic proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes:

• Intérpretes
• Información escrita en otros

Si necesita recibir estos servicios, comuníquese con Compliance Coordinator.

Si considera que Mangum Hospital and Mangum Family Medical Clinic no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad, exo, orientacionsexual, identidad de genero, religion, o habilidad para pagar puede presentarun reclamo a la siguiente persona:

Mangum Hospital and Mangum Family Medical Clinic Compliance Coordinator

Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, Compliance Coordinator, está a su disposición para brindársela.

También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación:

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)

Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.