Mid Atlantic Gynecologic Oncology and Pelvic Surgery Associates

Appointments (571) 308-1830

Nondiscrimination and Accessibility

SECTION 1557 OF THE AFFORDABLE CARE ACT

Northern Virginia Pelvic Surgery Associates complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Northern Virginia Pelvic Surgery Associates does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Northern Virginia Pelvic Surgery Associates:

► 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 interpreter
  • Information written in other languages

If you need these services, contact our Civil Rights Coordinator: Sheila Whitt.

If you believe that Northern Virginia Pelvic Surgery Associates 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:

Sheila Whitt, Practice Administrator
Northern Virginia Pelvic Surgery Associates
3289 Woodburn Road, Suite 320
Annandale, VA 22003
571-308-1830
571-308-1843 fax
Sheila.whitt@magopsa.com

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

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.