Upper Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, sex, age, or disability. Upper Dental does not exclude people or treat them differently because of race, color, national origin, sex, age, or disability.
Our Commitment to Equal Access
Upper Dental is committed to providing a welcoming and inclusive environment for all patients. We believe that every individual deserves equal access to quality dental care, regardless of background or personal characteristics. This commitment applies to all services, programs, and activities offered by the practice.
Who This Notice Covers
This notice applies to all patients, prospective patients, and visitors of Upper Dental. It covers every aspect of our services, including scheduling appointments, receiving treatment, and accessing patient information. Our non-discrimination policy extends to all interactions with our staff, doctors, and facilities.
Protections Under Federal Law
Section 1557 of the Affordable Care Act
Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives Federal financial assistance. Upper Dental complies fully with Section 1557 and its implementing regulations.
Other Applicable Civil Rights Laws
Upper Dental also complies with Title VI of the Civil Rights Act of 1964 (which prohibits discrimination based on race, color, and national origin), Title IX of the Education Amendments of 1972 (which prohibits discrimination based on sex), the Age Discrimination Act of 1975, and Section 504 of the Rehabilitation Act of 1973 (which prohibits discrimination based on disability).
Language Assistance and Accessibility Services
Free Language Assistance
Upper Dental provides free language assistance services to patients whose primary language is not English. Our staff is fluent in both English and Spanish, and we can arrange for additional interpreter services at no cost to you. If you need language assistance, please let us know. For more information about how we protect your health information, please see our Notice of Privacy Practices.
Auxiliary Aids and Services for Individuals with Disabilities
We provide appropriate auxiliary aids and services, including qualified sign language interpreters and written materials in alternative formats (such as large print or braille), free of charge to individuals with disabilities. To request these services, please contact our office. For more information about our facility accessibility, please review our Accessibility Statement.
How to File a Grievance or Civil Rights Complaint
Internal Grievance Process
If you believe that Upper Dental has failed to provide these services or discriminated in another way on the basis of race, color, national origin, sex, age, or disability, you may file a grievance with our Civil Rights Coordinator. Grievances must be submitted in writing within 60 days of the alleged incident. You can obtain a grievance form by visiting our Patient Information page or by contacting our office directly at our Contact page.
[Civil Rights Coordinator: Name and contact information to be inserted by practice administrator]
Filing a Complaint with the U.S. Department of Health and Human Services
You may 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, 1-800-537-7697 (TDD)
Complaint forms are available at https://www.hhs.gov/ocr/complaints/index.html.
