Johns Hopkins Medicine Entities:

Similar documents
Notice of Denial of Medical Coverage

2019 Formulary Monthly Notice of Change

Appendix A to Part 92 Notice Informing Individuals About Nondiscrimination and

APPOINTMENT OF REPRESENTATIVE

Community Care Family Care Partnership Program (HMO SNP) (Community Care) 2019 Pharmacy Directory

SELECTIONS. Welcome to the UPMC MyHealth Selections program

Preventive Health Care Guide Adults. Save and share with your doctor! Primary Care Office Visits. Screening Schedule. Immunization Schedule

ENHANCED FORMULARY for Medicare Plus Group Members

Summary of Benefits. Humana Walmart Rx Plan (PDP) State of North Carolina. Our service area includes the following state(s): North Carolina.

2019 Summary of Benefits Medicare Prescription Drug Plans. BlueMedicare Value Rx (PDP) S

Healthy Moves. A better flu season for you

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

TRANSITION OF CARE APPLICATION

Kadlec Regional Medical Center 0118 KMC-002B

2019 Over-the-Counter Drugs and Vitamins - Puerto Rico*

COMPOUNDED PRESCRIPTION DRUG PRODUCTS

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Our dental plan for individuals age 65 and over

SENSIPAR 1 (CINACALCET) UTILIZATION MANAGEMENT CRITERIA

There are 2 kinds of appeals with Blue Cross of Idaho Care Plus

Healthy Moves. Top Five Tips for Aging Better. Summer 2017

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Page 1. Utilization Management Policy Name: Topical Tretinoin Products Restricted Product(s): Unrestricted/Suggested Alternative(s):

Dental Blue 65. Outline of Coverage. Dental Blue 65 Preventive Dental Blue 65 Basic Dental Blue 65 Premier Effective January 1, 2017

Personal Dental Coverage with Optional VisionBlueSM. Affordable Dental Plans for Individuals of All Ages

2018 Formulary Annual Notice of Change

Doxazosin Dutasteride Finasteride Tamsulosin Viagra (sildenafil) benefit limitations apply

Kaiser Permanente 2018 Pharmacy Directory

2018 PDP Summary of Benefits

Member Matters Newsletter

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

GCHJUV2EN Member Registration Guide

FRM016178CO00 (10/17)

2019 Pharmacy Directory

IN THIS ISSUE MEMBER NEWSLETTER AUGUST Dear Amida Care Members,

Optional Supplemental Benefits Gold Benefits Enrollment Form

UTILIZATION MANAGEMENT CRITERIA

BUPROPION/NALTREXONE (Contrave 1 ) LORCASERIN (Belviq 1, Belviq XR 1 ) PHENTERMINE/TOPIRAMATE ER (Qsymia 1 )

Health Net Transition of Care Form. Welcome to Health Net! To be completed by agent: New member medical care checklist. Agent name M M D D Y Y Y Y

Affordable Care Act Section 1557 Nondiscrimination Policy for Kentucky

Josette E. Spotts, MD, FACS W. Warm Springs Road, Suite 105 Henderson, NV Tel: Fax:

CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX. PRESCRIBER ADDRESS CITY STATE ZIP Formulary Drug? Yes No

Getting to the BOTTOM OF BACK PAIN

CheckUp. Today. Free Diabetes Education Class. Sign Up. Fall More Diabetes Tips

Get $150 back! WELL-BEING. Start your well-being journey today! Complete 120 workouts at an approved fitness center ACHIEVE

Family and Self Health History for Genetic Counseling. Your Personal Health History

Notice of Appeal Resolution

ATYPICAL ANTIPSYCHOTICS

NOTICE OF ADVERSE BENEFIT DETERMINATION About Your Treatment Request

Member Grievance Form

Your Feelings Matter WITH TYPE 2 DIABETES

Sore Throat or Strep? ALWAYS GET A STREP TEST BEFORE TAKING AN ANTIBIOTIC

Take Charge of YOUR COPD

Complete. Pennsylvania. How your plan works. Calendar year deductible This is the amount you will pay out-of-pocket for services in a calendar year

Kaiser Permanente 2018 Sample Fee List *

A healthy smile just got easier with our dental benefit!

The FitnessCoach Program

Life After a Heart Attack WHAT ARE MY CHANCES OF HAVING ANOTHER HEART ATTACK?

Notice of Appeal Resolution

Health TALK. Easy access. KidsHealth. Options for women s health services.

TRIPTAN RESTRICTED ACCESS; QUANTITY LIMIT EXCEPTION CERTIFICATION FAX REQUEST FORM

Indemnity PPO Medical Plan Preventive Care Guidelines

Living with DIABETES

Kaiser Permanente 2019 Sample Fee List-Signature *

2017 Pharmacy Directory

Federal DentalBlue. Standard and Basic Options

Solutions Fitness Program

Warfarin. (Coumadin, Jantoven ) Taking your medication safely

Member Registration Guide GCHJUV2EN 0117

Community Health Access Program Account Change Form

Appeals & Grievances Department REQUEST FOR RECONSIDERATION (APPEAL) Part C MEMBER NAME: HNET Member ID Number:

MARIPOSA COUNTY HUMAN SERVICES PROVIDER LIST

ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) PRIOR REVIEW/CERTIFICATION FAXBACK FORM

Healthy. Now. vaccines? Is your child up to date on. page 4. Keep blood pressure in check with this healthy low-sodium recipe.

CCCN Patient Questionnaire

2018 Annual Notice of Changes

Growth Hormones (GH) UTILIZATION MANAGEMENT CRITERIA

Healthy Kids Dental Handbook

Request for Redetermination of Medicare Prescription Drug Denial

Notice About Nondiscrimination and Accessibility Requirements

GET REWARDED. by connecting your fitness device to Go365 COMPATIBLE FITNESS DEVICES GCHJHTFEN 0718

One mission: you Dental Plans. for Groups. Policy Form Numbers: (11-09) (11-09) (09-12) (01-15) Form No.

2018 Pharmacy Directory

Health TALK. Mammograms save lives. Plan to quit.

TruHearing. Supplemental Benefit Directory. RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal.

Oncology OUTPATIENT GUIDE

Page 1. Unrestricted/Suggested Alternative(s): generic formulations of ADHD medications unless otherwise noted. Quantity limits apply.

HealthyFocus Spring 2017

Expand your employees health care literacy by educating them about safe and simple ways to dispose of unused or expired prescription drugs.

Description of Benefits and Copayments. AvMed Medicare. Broward / Miami-Dade Counties

The benefit of knowing

February is National Heart Month

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Transcription:

Johns Hopkins health care providers and all employees of Johns Hopkins Medicine comply with applicable Federal civil rights laws and do not discriminate against, exclude, or treat people differently on the basis of race, color, ethnicity, national origin, age, language, physical or mental disability, religion, sex, sexual orientation, and gender identity or expression. Organizations that follow this Notice (collectively Johns Hopkins Medicine Entities ) include all Johns Hopkins health care providers providing health care to the public at their delivery sites and employees of Johns Hopkins Medicine, including those listed in this Notice. Johns Hopkins Medicine Entities: provide 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); and provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages If you need these services, you or your representative may inform a member of your treatment team, such as a nurse, advance practice practitioner, or physician. If you or your representative believe that the Johns Hopkins Entity from which you are receiving medical services has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you or your representative may contact the Patient Relations office to initiate a formal complaint or grievance. If you need help with submitting your grievance, you may obtain assistance from the Patient Relations Office or other appropriate point of contact at your Johns Hopkins Medicine Entity at the corresponding phone number below:

Howard County General Hospital 5755 Cedar Lane Columbia, MD 21044 410-720-8200 hcghpatientrelations@jhmi.edu Johns Hopkins Bayview Medical Center 4940 Eastern Ave. 410-550-0626 patientexperiencebayview@jhmi.edu Johns Hopkins Elder Plus Program 4940 Eastern Avenue Mason F. Lord Building; East Tower 1 st Floor 410-550-7044 Johns Hopkins Home Care Group 5901 Holabird Avenue, Suite A 410-288-6320 PtExperience_JHHCG@jhmi.edu Ophthalmology Associates Signature OB/GYN Johns Hopkins All Children s Hospital 501 Sixth Avenue South St. Petersburg, FL 33701 727-767-8959 1-800-456-4543, ext. 78959 achriskmanagement@jhmi.edu Johns Hopkins Community Physicians 3100 Wyman Park Dr. Baltimore, MD 21211 410-516-0106 jhcpfeedback@jhmi.edu Johns Hopkins HealthCare Nondiscrimination Grievance Telephone numbers: 844-697- 4071 or 844-422-6957 Nondiscrimination Grievance TTY number: 711 Nondiscrimination Grievance Fax numbers: 410-762-1502 or 410-762-1527 Nondiscrimination Grievance Email addresses: compliance@jhhc.com or medicarecompliance@jhhc.com The Johns Hopkins Hospital Sibley Memorial Hospital 5355 Loughboro Road Washington, DC 20016 202-537-4486 sibleypatrelations@jhmi.edu Suburban Hospital 8600 Old Georgetown Road Bethesda, MD 20814 301-896-3822 suburbanpatrelations@jhmi.edu 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.

English ATTENTION: If you speak a non-english language, we offer you language assistance services, free of charge. Call 1-410-614-4685 (TTY: 711). Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነየትርጉም እርዳታ ድርጅቶች በነጻ ሊያግዝዎት ተዘጋጀተዋል ወደ ሚከተለው ቁጥር ይደውሉ 410-614-4685 (መስማት ለተሳናቸው: 711). Arabic Bengali ملحوظة: إذا كنت تتحدث اذكر اللغة فا ن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-410-614-4685- (رقم ھاتف الصم والبكم: 711). ল ক ন য দআপ নব ল, কথ বল তপ রন, ত হ ল ন খরচ য়ভ ষ সহ য়ত প র ষব উপল আ ছ ফ নক ন১-410-614-4685 (TTY: 711) Burmese သတ ပ ရန - အကယ သင သည မန မ စက က ပ ပ က ဘ သ စက အက အည အခမ သင အတ က စ စဥ ဆ င ရ က ပ ပ မည ဖ န န ပ တ 1-410-614-4685 (TTY: 711) သ ႔ ခၚဆ ပ Chinese 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 410-614-4685(TTY:711) French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 410-614-4685 (ATS : 711). French Creole (Haitian Creole) ATANSYON: Si w pale KreyòlAyisyen, gen sèvisèdpoulangkidisponib gratis pouou. Rele 410-614-4685 (TTY: 711). German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 410-614-4685 (TTY: 711). Greek ΠΡΟΣΟΧΗ: Αν ομιλείτε ελληνικά, σας παρέχονται δωρεάν υπηρεσίες γλωσσικής βοήθειας. Καλέστε στο 410-614-4685 (Λειτουργία τηλεφώνου κειμένου: 711). Gujarati સ ચન : જ તમ ગ જર ત બ લત હ, ત ન:શ ક ભ ષ સહ યસ વ ઓતમ ર મ ટ ઉપલ ધછ. ફ ન કર 410-614-4685 (TTY: 711). Hindi ध य न द : य द आप ह द ब लत ह त आपक लए म फ त म भ ष सह यत स व ए उपलब ध ह 410-614-4685 (TTY: 711) पर क ल कर Ibo Igenti: O burunaasu Ibo asusu, enyemakadirigi site na call 1-410-614-4685 (TTY: 711). Italian ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 410-614-4685 (TTY:711).

Japanese 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます 410-614-4685 (TTY:711) まで お電話にてご連絡ください Korean 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 410-614-4685 (TTY: 711) 번으로전화해주십시오. Kru (Bassa), Dèɖɛnìàkɛdyéɖégbo: Ɔ jǔké m [Ɓàsɔ ɔ -wùɖù-po-nyɔ ] jǔní, nìí, à wuɖukàkòɖòpo-poɔ ɓɛ ìn m gbokpáa. Ɖá 410-614-4685 (TTY: 711) Mon-Khmer, Cambodian របយ ត ប ស ន អ កន យ ខ រ, ស ជ ន យ ផ ក យម នគ តឈ លគ ច នស ប ប រ អ ក ច រទ រស ព 1-410-614-4685 (TTY: 711) Pennsylvania Dutch Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 410-614-4685 (TTY: 1-711). Persian (Farsi) Polish توجھ: اگر بھ فارسی صحبت می کنید خدمات ترجمھ بھ صورت رایگان در اختیارتان قرار می گیرد. با (711 (TTY: 410-614-4685 تماس بگیرید. UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 410-614-4685 (TTY: 711). Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 410-614-4685 (TTY: 711). Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 410-614-4685 (телетайп: 711). Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 410-614-4685. (TTY: 711). Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-410-614-4685 (TTY: 711). Thai เร ยน :ถ าค ณพ ดภาษาไทยค ณสามารถใช บร การช วยเหล อทางภาษาได ฟร โทร 410-614-4685 TTY: 711 ) Urdu Vietnamese توجہ فرماي یں: اگر آپ اردو زبان بولتے ہیں تو زبان میں معاونت کی خدمات آپ کو مفت میں دستیاب ہیں کال کریں (711 (TTY: 410-614-4685 CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số1-410-614-4685 (TTY: 711). Yoruba AKIYESI: Ti o bansoede Yoruba ofeniiranlowoloriedewa fun yin o. E peeroibanisoroyi 410-614-4685 (TTY: 711).