This practice serves all patients regardless of inability to pay.

Discounts for essential services are offered based on family size and income.

For more information contact our office.

 

North Florida Pediatrics complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. North Florida Pediatrics does not exclude people or treat people differently because of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.

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North Florida Pediatrics:

• 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, or other formats)

• Provides free language services to people whose primary language is not English, such as:

  • Qualified interpreters

  • Information written in other languages

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If you need these services, please contact us at our office.

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Should you believe that North Florida Pediatrics has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may file a grievance toward:

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Samuel Santelices, M.D.
1859 SW Newland Way
Lake City, FL 32025
Phone: (386) 758-0003, (TTY (386) 758-0003)
Fax: (386) 755-4432

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You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, we are 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:

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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)

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

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ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (386) 758-0003 (TTY: (386) 758-0003)

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ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (386) 758-0003 (TTY: (386) 758-0003)

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CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (386) 758-0003 (TTY: (386) 758-0003)

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ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (386) 758-0003 (TTY: (386) 758-0003)

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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 (386) 758-0003 （TTY：(386) 758-0003）。

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ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (386) 758-0003 (ATS : (386) 758-0003)

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PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (386) 758-0003 (TTY: (386) 758-0003)

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ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (386) 758-0003 (телетайп: (386) 758-0003)

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ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-xxxx-xxx-xxx) رقم .(xxx-xxx-xxxx-1 :والبكم الصم ھ

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ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (386) 758-0003 (TTY: (386) 758-0003)

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ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (386) 758-0003 (TTY: (386) 758-0003)

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주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (386) 758-0003 (TTY: (386) 758-0003)번으로 전화해 주십시오

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UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (386) 758-0003 (TTY: (386) 758-0003)

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સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો (386) 758-0003 (TTY: (386) 758-0003)

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เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร (386) 758-0003 (TTY: (386) 758-0003)

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