Discrimination is Not Tolerated in This Medical Practice (WTMF)

Washington Township Medical Foundation

In accordance with the ethical standards of the medical profession, Washington Township Medical Foundation complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Our practice also does not exclude people or treat them differently due to race, color, national origin, age, disability, or sex. We provide the following:

• 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, other formats)
• 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 inform our practice: Art Gomez, Director of Quality and Compliance: 2500 Mowry Ave, Suite 255, Fremont, CA 94538. Phone 510-248-1055, fax 510-608-6055, or e-mail at art_gomez@mywtmf.com.

If you believe that Washington Township Medical Foundation 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:

Art Gomez, Director of Quality and Compliance
2500 Mowry Ave., Suite 255, Fremont, CA 94538
(P) 510-248-1055, (F) 510-608-6055
art_gomez@mywtmf.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Christian Rieta 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/smartscreen/main.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
(800) 368-1019, or 800-537-7697 (TDD)

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

For additional languages, click here.