Nondiscrimination Notice

Baylor Scott & White Surgicare Fort Worth complies with applicable Federal civil rights laws and does 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.  Baylor Scott & White Surgicare Fort Worth 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.  Our health plans are also subject to the section 1557 nondiscrimination requirements and will be operated accordingly.

Baylor Scott & White Surgicare Fort Worth:

  • Provides 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
  • Provides 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 Baylor Scott & White Surgicare Fort Worth’s ADA Coordinator at 817-334-5100.

If you believe that Baylor Scott & White Surgicare Fort Worth 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:

ADA Coordinator
Baylor Scott & White Surgicare Fort Worth
750 12th Avenue
Fort Worth, Texas 76104
Phone: 817-334-5100
Fax: 817-570-0280
opena@uspi.com

You can file a grievance in person or by mail, fax or email.  If you need help filing a grievance, Baylor Scott & White Surgicare Fort Worth’s ADA Coordinator 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

 

English

ATTENTION:  If you speak another language, language assistance services, free of charge, are available to you.  Call 1-817-334-5100 (TTY: 1-817-334-5100).

Spanish

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-817-334-5100 (TTY: 1-817-334-5100).

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 1-817-334-5100(TTY:1- 817-334-5100)。

Vietnamese

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-817-334-5100 (TTY: 1-817-334-5100).

Korean

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-817-334-5100 (TTY: 1-817-334-5100)번으로 전화해 주십시오.

French

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-817-334-5100 (ATS : 1-817-334-5100).

Tagalog

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-817-334-5100 (TTY: 1-817-334-5100).

Russian

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-817-334-5100 (телетайп: 1-817-334-5100).

German

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-817-334-5100 (TTY: 1-817-334-5100).

Gujarati

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો  1-817-334-5100 (TTY: 1-817-334-5100).

Arabic

ملحوظة:  إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم 1-817-334-5100 (رقم هاتف الصم والبكم: 1-817-334-5100).

Portuguese

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-817-334-5100 (TTY: 1-817-334-5100)

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。1-817-334-5100(TTY:1-817-334-5100)まで、お電話にてご連絡ください。

Ukrainian

УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-817-334-5100 (телетайп: 1-817-334-5100).

Hindi

ध्यान दें:  यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-817-334-5100 (TTY: 1-817-334-5100) पर कॉल करें।

Mon-Khmer, Cambodian

ប្រយ័ត្ន៖  បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។  ចូរ ទូរស័ព្ទ 1-817-334-5100 (TTY: 1-817-334-5100)។