Jackson, MI Pediatric Dentistry

   (517) 787-1022   3386 Spring Arbor Road, Suite 2, Jackson, MI 49203

HomeHIPAA Non-Discrimination Notice

HIPAA Non-Discrimination Notice

Jackson Pediatric Dentistry complies with applicable Federal Civil Rights Laws and does not discriminate based on race, color, national origin, age, disability, or sex.

Jackson Pediatric Dentistry does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We provide free aids and services to people with disabilities to communicate effectively with us, such as HIPAA interpretation in written format, written information in large print, and audio-accessible formats via www.HHS.gov, 800#, electronic formats & hard copies.

We also comply with HIPAA law by providing free HIPAA translation to people whose primary language is not English. For language translation in the top 15 common languages, we will have you call 800-752-0093. Please contact our HIPAA Officer for additional guidance on these translation links or other communication aids at the phone number listed below.

If you believe that Jackson Pediatric Dentistry has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability, or sex, you can file a grievance with:

  • HIPAA Officer: Rachel Crouse
  • Office Name: Jackson Pediatric Dentistry
  • Office Address: 3386 Spring Arbor Rd Suite2 Jackson, MI 49203
  • Office Phone: 517-787-1022
  • Office Fax: 517-787-2150

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/lobbv.isfor by U.S. mail or telephone:

  • Office: U.S. Department of Health and Human Services
  • Address: 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201
  • Phone: 800-368-1019
  • Fax: 800-537-7697
  • Language Translation Phone: 800-752-0093

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.