3105 Rock Hill Church Road, Suite 101
Concord, NC 28027
704-793-1329
Pure Chiropractic, PLLC
Your Rights
Civil rights are personal rights guaranteed and protected by the U.S. Constitution and federal laws enacted by Congress, such as the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990. Civil rights include protection from unlawful discrimination. Under these laws, all persons in the United States have a right to receive health care and human services in a nondiscriminatory manner.
Our Non-Discrimination Statement
Jerry Pokorney, DC at Pure Chiropractic, PLLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This practice does not exclude people or treat them differently because of race, color, national origin, age disability, or sex. This practice:
· Provides information to patients in plain language and in a manner that is accessible and timely.
· Provides free services to people with disabilities to communicate effectively with us, including auxiliary aids.
· Provides free language assistance services to people whose primary language is not English.
If you need these services, contact our Practice’s Compliance Officer, Jerry Pokorney, DC.
If you believe that Jerry Pokorney DC 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 our Compliance Officer. You can file a grievance in person or by mail, or fax.
3105 Rock Hill Church Road, Suite 101, Concord, NC 28027
704-793-1329
704-793-1392
If you need help filing a grievance our Compliance Officer 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.
Tagline – NC Providers
Information of Language Assistance Services
for Individuals with Limited English Proficiency
· Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-704-793-1329.
· 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 1-704-793-1329。
· Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-704-793-1329.
· Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-704-793-1329 번으로 전화해 주십시오.
· French: ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont roposes gratuitement. Appelez le 1-704-793-1329.
· Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-704-793-1329.
· Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-704-793-1329.
· Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-704-793-1329.
· Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-704-793-1329.
· Gujarati: સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-704-793-1329.
· Mon-Khmer, Cambodian: ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ 1-704-793-1329។
· German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-704-793-1329.
· Hindi: ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-704-793-1329 पर कॉल करें।
· Laotian: ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-704-793-1329.
· 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。1-704-793-1329 まで、お電話にてご連絡ください。
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