Silver Jayne
Compliance Officer
5344 Central Avenue Charlotte, NC 28212
Phone: 704-940-4000
Fax: 704-940-4001
dr.silver@keithclinic.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Miriam Aguilar, 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.
This notice is available at Keith Clinic Estramonte Chiropractic’s website: www.keithclinic.com
If you do not speak English, language assistance services, free of charge, are available to you.
Call 704-935-2883.
សូ មយកចិត្តទុកដាក់៖ ប្រសិនបរើអ្នកនិយាយ ភាសាខ្មែរ បសវាកមែជំនួយភាសា ឥត្គិត្ថ្លៃគឺមានសប្មារ់អ្នក។ ជំនួយ និងបសវាកមែខ្ែលជាការជួយែ៏សមរមយ កន ុងការផ្តល់ព័ត្៌មានតាមទប្មង់ ខ្ែលអាចចូលបប្រើប្ាស់ាន ក៏អាចរកាន បដាយឥត្គិត្ថ្លៃផ្ងខ្ែរ។ បៅទូរសពទបៅ 704-935-2883 ឬនិយាយបៅកាន់អ្នកផ្តល់បសវាររស់អ្នក។”
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