Patient Notice of Rights in Accordance with the American Disabilities Act
Perfect Dental Management and its affiliated practices are dedicated to providing services to patients, companions and visitors in a welcoming manner that respects, protects, and promotes patient rights.
Our team members will treat all patients, companions and visitors receiving services with equality in a welcoming manner that is free from discrimination based on age, race, color, creed, ethnicity, religion, nation origin, marital status, sex, sexual orientation, gender identity or expression, disability, veteran or military status, or any other basis prohibited by federal, state, or local law.
Our team will determine eligibility for and provide services, and other benefits to all patients, companions and visitors in a similar manner, without subjecting any individual to sparate or different treatment on the basis of age, race, color, creed, ethnicity, religion, national origin, marital status, sex, sexual orientation, gender identity or expression, disability, veteran or military status, or any other basis prohibited by federal, state, or local law.
Our team members will inform patients, companions of the availability of and make reasonable accommodations for disabled patients consistent with federal and state requirements at no cost to the patient.
Any person, who believes that he, she or another person has been subjected to discrimination which is not permitted, may file a complaint with the VP of Compliance/Compliance Coordinator.
Our team members are prohibited from retaliating against any person who opposes, complains about, or reports discrimination, files a complaint, or cooperates in an investigation of discrimination or other proceeding under federal, state, or local anti-discrimination law.
If you have a discrimination complaint you can report it to any team member or to the Compliance Coordinator in writing without fear of retaliation.
If you feel you have not received proper assistance with your complaint, 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 & Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-844-883-6627, 844-883-6627 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html