A. Prohibition of Discrimination
C. Qualified Interpreter
D. Notice to Community
Sign language and oral interpreters, TTYs, and other auxiliary aids and services are available free of charge to people who are deaf or hard-of-hearing. For assistance, please contact any Center Personnel or the Information Office at _____________(voice/TTY), room ______.
These signs will include the international symbols for “interpreters” and “TTYs.”
To ensure effective communication with Patients and their Companions who are deaf or hard-of-hearing, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, video remote interpreting services, TTYs, note takers, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with caption capability or closed caption decoders, and open and closed captioning of most DeKalb Regional’s programs.
Please ask any Center Personnel for assistance, or contact the Information Office at ______________ (voice or TTY), room _________________.
DeKalb Regional will also include in their Consumers’ Rights a description of their complaint resolution mechanism.
If you recognize or have any reason to believe that a Patient or a relative, close friend, or Companion of a Patient is deaf or hard-of-hearing, you must advise the person that appropriate auxiliary aids and services, such as sign language and oral interpreters, video remote interpreting services, TTYs, note takers, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, televisions with captioning or closed caption decoders, and open and closed captioning of most facility programs, will be provided free of charge when appropriate. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate ADA Administrator at _____________ and reachable at ________________.
DeKalb Regional will post this policy on the intranet within thirty (30) days of the Effective Date of this Agreement to all Center Personnel and both employed and affiliated physicians (physicians with practicing or admitting privileges), and to all new Center Personnel and newly employed or affiliated physicians upon their affiliation or employment with DeKalb Regional.
G. Report, Monitoring, and Violations
DeKalb Regional will maintain records to document the information contained in the Compliance Report and will make them available, upon request, to the United States Attorney’s Office.
H. Compensatory Relief for Complainants and Release
Aileen Bell Hughes
Assistant United States Attorney
75 Spring Street, S.W. Suite 600
Atlanta, Georgia 30303
I. Enforcement and Miscellaneous
H. Joseph Colette
Owen, Gleaton, Egan, Jones & Sweeney, LLP
Georgia Bar No. 170045
John A. Horn
Acting United States Attorney
United States Attorney’s Office
Northern District of Georgia
600 U.S. Courthouse
75 Spring Street SW
Atlanta, GA 30303
(404) 581-6000 fax (404) 581-6181
Aileen Bell Hughes
Assistant United States Attorney
Georgia Bar No. 375505
Aileen.bell.hughes@usa.doj.gov
Emily Shingler
Assistant United States Attorney
Georgia Bar No. 311482
Emily.shingler@usa.doj.gov
We ask this information so we can communicate effectively with Patients and/or Companions. All communication aids and services are provided FREE OF CHARGE. If you need further assistance, please ask your nurse or other Hospital Personnel.
Date:
Name of Patient or Companion:
Nature of Disability:
Deaf
Hard of Hearing
Other: __________________
Relationship to Patient:
Self
Family member
Friend
Other: ________________
Does the person with a disability want an onsite professional sign language or oral interpreter?
Yes. Choose one (free of charge):
American Sign Language (ASL)
Signed English
Oral interpreter
Other. Explain: _________________
No.
Which of the following would be helpful for the person with a disability? (free of charge)
TTY/TDD (text telephone)
Assistive listening device (sound amplifier)
Qualified note-takers
Writing back and forth
Other. Explain: __________________
If the person with a disability, or the Patient who the person with a disability is with, is
ADMITTED to the hospital, which of the following should be provided in the patient room?
Video remote interpreting
Telephone handset amplifier
Telephone compatible with hearing aid
TTY/TDD
Flasher for incoming calls
Paper and pen for writing notes
Other. Explain: __________________________________
Any questions?
Please call _________ (voice),_______________ (TTY), or visit us during normal business hours. We are located in room ____________________________