ATTENTION: If you do not speak english, language assistance services, free of charge, are available to you. Call 1-800-220-6277. Discrimination is Against the Law Colfax and Havana Dental Partners, PLLP: Complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Colfax and Havana Dental Partners, PLLP: Does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Colfax and Havana Dental Partners, PLLP: 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) Colfax and Havana Dental Partners, PLLP: 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 Dr. Jeffrey Crane. If you believe that Colfax and Havana Dental Partners, PLLP 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: Dr. Jeffrey Crane, Compliance Officer 10401 E Colfax Ave
Aurora, CO 80010 Phone: 303-344-2273 Fax: 303-344-2286 jcrane@comfortdental.biz You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Dr. Jeffrey Crane, Compliance Officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and HumanServices, 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