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Nondiscrimination Notice and Access to Communication Services 

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Empire Physicians Medical Group do not discriminate on the basis of sex, age, race, color, national origin, or disability. 

Free services are available to help you communicate with us. Such as, letters in other languages, or in other formats like large print. Or, you can ask for an interpreter. To ask for help, please call Toll-Free: 1-800-956-8000, Option 5. TTY 711. 

If you think you weren’t treated fairly because of your sex, age, race, color, national origin, or disability, you can send a complaint to: 

Civil Rights Coordinator 
11000 Optum Circle 
Eden Prairie, MN 55344 
Fax:  855-351-5495  
Email:  Optum_Civil_Rights@Optum.com

If you need help with your complaint, please call the toll-free number 888-445-8745. TTY 711.  You must send the complaint within 60 days of when you found out about the issue. 

You can also file a complaint with the U.S. Dept. of Health and Human services.  
Online  https://ocrportal.hhs.gov/ocr/portal/lobby.jsf 
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD) 
Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 

Language Assistance Services and Alternate Formats

This information is available in other formats like large print. To ask for another format, please call Toll-Free: 1-800-956-8000, Option 5. TTY 711. 

ATTENTION: If you speak English, language assistance services, free of charge, are available to you.

Please call:

1-800-956-8000, Option 5.

ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al Toll-Free: 1-800-956-8000, Option 5.

請注意:如果您說中文 (Chinese),我們免費為您提供語言協助服務。請致電:Toll-Free: 1-800-956-8000, Option 5.

XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ trợ giúp 

về ngôn ngữ miễn phí. Vui lòng gọi Toll-Free: 1-800-956-8000, Option 5.

알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니

다.Toll-Free: 1-800-956-8000, Option 5. 번으로 전화하십시오.

PAUNAWA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Mangyaring tumawag sa Toll-Free: 1-800-956-8000, Option 5.

ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык 

является русском (Russian). Позвоните по номеру Toll-Free: 1-800-956-8000, Option 5.

Toll-Free: 1-800-956-8000, Option 5. ﻓﺈن ﺧﺪﻣﺎت اﻟﻤﺴﺎﻋﺪة اﻟﻠﻐﻮﯾﺔ اﻟﻤﺠﺎﻧﯿﺔ ﻣﺘﺎﺣﺔ ﻟﻚ. اﻟﺮﺟﺎء اﻷﺗﺼﺎل ﺑـ ،)Arabic(ﺗﻨﺒﯿﮫ: إذا ﻛﻨﺖ ﺗﺘﺤﺪث العربية

ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki gratis pou ede w nan lang pa w. Tanpri rele nan Toll-Free: 1-800-956-8000, Option 5.

ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés gratuitement. Veuillez appeler le Toll-Free: 1-800-956-8000, Option 5.

UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza. Prosimy zadzwonić pod numer Toll-Free: 1-800-956-8000, Option 5.

ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de idiomas gratuito. Ligue para Toll-Free: 1-800-956-8000, Option 5.

ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Si prega di chiamare il numero Toll-Free: 1-800-956-8000, Option 5.

ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos 

sprachliche Hilfsdienstleistungen zur Verfügung. Rufen Sie Toll-Free: 1-800-956-8000, Option 5. an.

注:日本語(日本語)を話す場合は、無料の言語サポートサービスを利用できます。またはフリーダイヤル:1-800-956-8000, Option 5までお電話ください。

 اﺳﺖ، ﺧﺪﻣﺎت اﻣﺪاد زﺑﺎﻧﯽ ﺑﮫ طﻮر راﯾﮕﺎن در اﺧﺘﯿﺎر ﺷﻤﺎ ﻣﯽ ﺑﺎﺷﺪ. )i sraF(ﺗﻮﺟﮫ: اﮔﺮ زﺑﺎن ﺷﻤﺎ فارسی   ﺗﻤﺎس ﺑﮕﯿﺮﯾﺪ. Toll-Free: 1-800-956-8000, Option 5.

कृपा धयान दें: यदद आप ह .दी (Hindi) भाषी हैं तो आपके िलए भाषा सहायता सेवाएं 

नन:शुिक उिप ध हैं। कृपा पर काि क रें Toll-Free: 1-800-956-8000, Option 5.

CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov 

hu rau Toll-Free: 1-800-956-8000, Option 5.

ចំណាប់អារម្មណ ៍ៈ  បេេេេបើសិនអ្នកនិយាយភាសាខ្ មមរ(Khmer)បសវាជំនួយភាសាបោយឥតគិតថ្ ៃល គឺមានសំរាប់អ្នក។ សូម្ទូរស័ព្ទ បៅបេម Toll-Free: 1-800-956-8000, Option 5.។

PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti Toll-Free: 1-800-956-8000, Option 5.

DÍÍ BAA'ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti'go, saad bee áka'anída'awo'ígíí, t'áá jíík'eh, bee ná'ahóót'i'. T'áá shoodí kohjį'  Toll-Free: 1-800-956-8000, Option 5. hodíilnih.

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wa c Toll-Free: 1-800-956-8000, Option 5.