Greenview Cosmetic and Family Dentistry complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)).
Greenview Cosmetic and Family Dentistry does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Greenview Cosmetic and Family Dentistry:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, please contact the Practice Manager or Patient Care Coordinator. If you believe that Greenview Cosmetic and Family Dentistry 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:
- Director of Patient Experience
2200 County Road C West, Suite 2210
Roseville, MN 55113
Phone: (651) 633-0500
Fax: (651) 636-6350
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Director of Patient Experience is available to help you.
You can also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights by mail or phone at:
- US Department of Health and Human Service
200 Independence Ave SW, Room 509F, HHH Building
Washington, DC 20201
Toll Free: (800) 368-1019
(800) 537-7697 (TDD)
or electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at http://www.hhs.gov/ocr/oce/file/index.html.
Grievance Procedure:
It is against the law for Greenview Cosmetic and Family Dentistry to intimidate, threaten, coerce, retaliate, or otherwise discriminate against anyone who files a grievance, or participates in the investigation of a grievance for the purpose of interfering with any right or privilege secured by Section 1557.
Procedure:
- Grievances must be submitted to the Director of Patient Experience within 60 days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
- A grievance should generally be in writing, containing the name and contact information of the person filing it as well as the alleged discriminatory action and alleged basis (or bases) of discrimination, the date the grievance was filed, and any other pertinent information.
- When a grievance includes allegations that would violate Section 1557, the Director of Patient Experience shall investigate the grievance. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the grievance.
- Greenview Cosmetic and Family Dentistry shall inform an individual that they have a right to reasonable modifications in the grievance procedure if needed.
- The Director of Patient Experience must keep confidential the identity of an individual who has filed a grievance under this part except as required by law or to carry out the purposes of this part, including the conduct on any investigation, including to investigate the grievance.
- Greenview Cosmetic and Family Dentistry will issue to the person who filed the grievance a written decision on the grievance no later than 30 days after its filing. The decision shall include the resolution date and a notice to the complainant of their right to pursue further administrative or legal remedies.
- Greenview Cosmetic and Family Dentistry will maintain the files and records relating to such grievances for at least three years from the date the grievance is resolved.
The person filing the grievance may appeal the written decision by writing to the Director of Patient Experience within 15 days of receiving the decision. The Chief Clinical Officer shall issue a written decision in response to the appeal no later than 30 days after its filing.
Greenview Cosmetic and Family Dentistry, through the Director of Patient Experience, will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided reasonable modifications, appropriate auxiliary aids and services, or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include but are not limited to providing these services in a timely manner and without cost to individuals being served to ensure that individuals have an equal opportunity to participate in the grievance process.
Source: HHS Office for Civil Rights
