Complete Eye Care

Affordable Care Act – Nondiscrimination Notice

Affordable Care Act (ACA) Nondiscrimination Notice

Green Eye Institute complies with applicable Federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, or sex. Green Eye Institute does not exclude people
or treat them differently because of race, color, national origin, age, disability or sex.

Green Eye Institute:

         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,
    other 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, contact the Practice Administrator.


If you believe that Green Eye Institute 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:

Practice Administrator
P.O Box 15729
Hattiesburg, MS 39404-5729
Phone, 601-268-5144

Fax, 601-268-5149

lsgreeni@megagate.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the
Practice Administrator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Service, 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
800-368-1019, 800-537-7697 (TDD)

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