HHS Notifications and Statements
English
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice english sample ce notice english](/tpn/gen/sample-ce-notice-english.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement english sample ce statement english](/tpn/gen/sample-ce-statement-english.jpg)
Español (Spanish)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice spanish sample ce notice spanish](/tpn/gen/sample-ce-notice-spanish.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement spanish sample ce statement spanish](/tpn/gen/sample-ce-statement-spanish.jpg)
(Chinese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice chinese trd sample ce notice chinese trd](/tpn/gen/sample-ce-notice-chinese-trd.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement chinese trd sample ce statement chinese trd](/tpn/gen/sample-ce-statement-chinese-trd.jpg)
Tiếng Việt (Vietnamese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice vietnamese sample ce notice vietnamese](/tpn/gen/sample-ce-notice-vietnamese.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement vietnamese sample ce statement vietnamese](/tpn/gen/sample-ce-statement-vietnamese.jpg)
(Korean)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice korean sample ce notice korean](/tpn/gen/sample-ce-notice-korean.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement korean sample ce statement korean](/tpn/gen/sample-ce-statement-korean.jpg)
Tagalog (Tagalog – Filipino)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice tagalog sample ce notice tagalog](/tpn/gen/sample-ce-notice-tagalog.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement tagalog sample ce statement tagalog](/tpn/gen/sample-ce-statement-tagalog.jpg)
Русский (Russian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice russian sample ce notice russian](/tpn/gen/sample-ce-notice-russian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement russian sample ce statement russian](/tpn/gen/sample-ce-statement-russian.jpg)
العربية(Arabic)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice arabic sample ce notice arabic](/tpn/gen/sample-ce-notice-arabic.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement arabic sample ce statement arabic](/tpn/gen/sample-ce-statement-arabic.jpg)
Kreyòl Ayisyen (French Creole)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice french creole haitian sample ce notice french creole haitian](/tpn/gen/sample-ce-notice-french-creole-haitian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement french creole haitian sample ce statement french creole haitian](/tpn/gen/sample-ce-statement-french-creole-haitian.jpg)
Français (French)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice french sample ce notice french](/tpn/gen/sample-ce-notice-french.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement french sample ce statement french](/tpn/gen/sample-ce-statement-french.jpg)
Polski (Polish)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice polish sample ce notice polish](/tpn/gen/sample-ce-notice-polish.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement polish sample ce statement polish](/tpn/gen/sample-ce-statement-polish.jpg)
Português (Portuguese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice portuguese european sample ce notice portuguese european](/tpn/gen/sample-ce-notice-portuguese-european.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement portuguese european sample ce statement portuguese european](/tpn/gen/sample-ce-statement-portuguese-european.jpg)
Italiano (Italian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice italian sample ce notice italian](/tpn/gen/sample-ce-notice-italian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement italian sample ce statement italian](/tpn/gen/sample-ce-statement-italian.jpg)
Deutsch (German)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice german sample ce notice german](/tpn/gen/sample-ce-notice-german.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement german sample ce statement german](/tpn/gen/sample-ce-statement-german.jpg)
(Japanese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice japanese sample ce notice japanese](/tpn/gen/sample-ce-notice-japanese.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement japanese sample ce statement japanese](/tpn/gen/sample-ce-statement-japanese.jpg)
فارسی (Farsi)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice persian farsi sample ce notice persian farsi](/tpn/gen/sample-ce-notice-persian-farsi.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement persian farsi sample ce statement persian farsi](/tpn/gen/sample-ce-statement-persian-farsi.jpg)
हिंदी (Hindi)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice hindi sample ce notice hindi](/tpn/gen/sample-ce-notice-hindi.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement hindi sample ce statement hindi](/tpn/gen/sample-ce-statement-hindi.jpg)
Հայերեն (Armenian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice armenian sample ce notice armenian](/tpn/gen/sample-ce-notice-armenian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement armenian sample ce statement armenian](/tpn/gen/sample-ce-statement-armenian.jpg)
ગુજરાતી (Gujarati)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice gujarati sample ce notice gujarati](/tpn/gen/sample-ce-notice-gujarati.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement gujarati sample ce statement gujarati](/tpn/gen/sample-ce-statement-gujarati.jpg)
Hmoob (Hmong)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice hmong sample ce notice hmong](/tpn/gen/sample-ce-notice-hmong.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement hmong sample ce statement hmong](/tpn/gen/sample-ce-statement-hmong.jpg)
اُردُو (Urdu)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice urdu sample ce notice urdu](/tpn/gen/sample-ce-notice-urdu.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement urdu sample ce statement urdu](/tpn/gen/sample-ce-statement-urdu.jpg)
ខ្មែរ (Cambodian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice cambodian sample ce notice cambodian](/tpn/gen/sample-ce-notice-cambodian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement cambodian sample ce statement cambodian](/tpn/gen/sample-ce-statement-cambodian.jpg)
ਪੰਜਾਬੀ (Punjabi)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice panjabi sample ce notice panjabi](/tpn/gen/sample-ce-notice-panjabi.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement punjabi sample ce statement punjabi](/tpn/gen/sample-ce-statement-punjabi.jpg)
বাংলা (Bengali)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice bengali sample ce notice bengali](/tpn/gen/sample-ce-notice-bengali.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement bengali sample ce statement bengali](/tpn/gen/sample-ce-statement-bengali.jpg)
אידיש(Yiddish)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice yiddish sample ce notice yiddish](/tpn/gen/sample-ce-notice-yiddish.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement yiddish sample ce statement yiddish](/tpn/gen/sample-ce-statement-yiddish.jpg)
አማርኛ (Amharic)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice amharic sample ce notice amharic](/tpn/gen/sample-ce-notice-amharic.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement amharic sample ce statement amharic](/tpn/gen/sample-ce-statement-amharic.jpg)
ภาษาไทย (Thai)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice thai sample ce notice thai](/tpn/gen/sample-ce-notice-thai.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement thai sample ce statement thai](/tpn/gen/sample-ce-statement-thai.jpg)
Oroomiffa (Oromo)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice cusite oromo sample ce notice cusite oromo](/tpn/gen/sample-ce-notice-cusite-oromo.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement cusite oromo sample ce statement cusite oromo](/tpn/gen/sample-ce-statement-cusite-oromo.jpg)
Ilokano (Ilocano)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice ilocano sample ce notice ilocano](/tpn/gen/sample-ce-notice-ilocano.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement ilocano sample ce statement ilocano](/tpn/gen/sample-ce-statement-ilocano.jpg)
ພາສາລາວ (Lao)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice lao sample ce notice lao](/tpn/gen/sample-ce-notice-lao.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement lao sample ce statement lao](/tpn/gen/sample-ce-statement-lao.jpg)
Shqip (Albanian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice albanian sample ce notice albanian](/tpn/gen/sample-ce-notice-albanian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement albanian sample ce statement albanian](/tpn/gen/sample-ce-statement-albanian.jpg)
Srpsko-hrvatski (Serbo-Croatian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice serbo croatian sample ce notice serbo croatian](/tpn/gen/sample-ce-notice-serbo-croatian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement serbo crotian sample ce statement serbo crotian](/tpn/gen/sample-ce-statement-serbo-crotian.jpg)
укРаїнська (Ukrainian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice ukrainian sample ce notice ukrainian](/tpn/gen/sample-ce-notice-ukrainian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement ukrainian sample ce statement ukrainian](/tpn/gen/sample-ce-statement-ukrainian.jpg)
नेपाली (Nepali)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice nepali sample ce notice nepali](/tpn/gen/sample-ce-notice-nepali.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement nepali sample ce statement nepali](/tpn/gen/sample-ce-statement-nepali.jpg)
Nederlands (Dutch)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice dutch sample ce notice dutch](/tpn/gen/sample-ce-notice-dutch.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement dutch sample ce statement dutch](/tpn/gen/sample-ce-statement-dutch.jpg)
unD (Karen)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice karen sample ce notice karen](/tpn/gen/sample-ce-notice-karen.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement karen sample ce statement karen](/tpn/gen/sample-ce-statement-karen.jpg)
Gagana fa'a Sāmoa (Samoan)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice samoan sample ce notice samoan](/tpn/gen/sample-ce-notice-samoan.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement samoan sample ce statement samoan](/tpn/gen/sample-ce-statement-samoan.jpg)
Kajin Ṃajōḷ (Marshallese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice marshallese sample ce notice marshallese](/tpn/gen/sample-ce-notice-marshallese.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement marshallese sample ce statement marshallese](/tpn/gen/sample-ce-statement-marshallese.jpg)
Română (Romanian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice romanian sample ce notice romanian](/tpn/gen/sample-ce-notice-romanian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement romanian sample ce statement romanian](/tpn/gen/sample-ce-statement-romanian.jpg)
Foosun Chuuk (Trukese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice trukese sample ce notice trukese](/tpn/gen/sample-ce-notice-trukese.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement trukese sample ce statement trukese](/tpn/gen/sample-ce-statement-trukese.jpg)
Tonga (Tongan)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice tongan sample ce notice tongan](/tpn/gen/sample-ce-notice-tongan.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement tongan sample ce statement tongan](/tpn/gen/sample-ce-statement-tongan.jpg)
Bisaya (Bisayan) .
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice bisyan sample ce notice bisyan](/tpn/gen/sample-ce-notice-bisyan.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement bisyan sample ce statement bisyan](/tpn/gen/sample-ce-statement-bisyan.jpg)
Ikirundi (Bantu – Kirundi)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice bantu kirundi sample ce notice bantu kirundi](/tpn/gen/sample-ce-notice-bantu-kirundi.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement bantu krundi sample ce statement bantu krundi](/tpn/gen/sample-ce-statement-bantu-krundi.jpg)
Kiswahili (Swahili)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice swahili sample ce notice swahili](/tpn/gen/sample-ce-notice-swahili.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement swahili sample ce statement swahili](/tpn/gen/sample-ce-statement-swahili.jpg)
Bahasa Indonesia (Indonesian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice indonesian sample ce notice indonesian](/tpn/gen/sample-ce-notice-indonesian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement indonesian sample ce statement indonesian](/tpn/gen/sample-ce-statement-indonesian.jpg)
Türkçe (Turkish)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice turkish sample ce notice turkish](/tpn/gen/sample-ce-notice-turkish.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement turkish sample ce statement turkish](/tpn/gen/sample-ce-statement-turkish.jpg)
کوردی (Kurdish)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice kurdish sample ce notice kurdish](/tpn/gen/sample-ce-notice-kurdish.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement kurdish sample ce statement kurdish](/tpn/gen/sample-ce-statement-kurdish.jpg)
తెలుగు (Teluga)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice teluga sample ce notice teluga](/tpn/gen/sample-ce-notice-teluga.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement teluga sample ce statement teluga](/tpn/gen/sample-ce-statement-teluga.jpg)
Thuɔŋjaŋ (Nilotic – Dinka)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice nlotic dinka sample ce notice nlotic dinka](/tpn/gen/sample-ce-notice-nlotic-dinka.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement nilotic dinka sample ce statement nilotic dinka](/tpn/gen/sample-ce-statement-nilotic-dinka.jpg)
Norsk (Norwegian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice norwegian sample ce notice norwegian](/tpn/gen/sample-ce-notice-norwegian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement norwegian sample ce statement norwegian](/tpn/gen/sample-ce-statement-norwegian.jpg)
Català (Catalan)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice catalan sample ce notice catalan](/tpn/gen/sample-ce-notice-catalan.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement catalan sample ce statement catalan](/tpn/gen/sample-ce-statement-catalan.jpg)
λληνικά (Greek)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice greek sample ce notice greek](/tpn/gen/sample-ce-notice-greek.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement greek sample ce statement greek](/tpn/gen/sample-ce-statement-greek.jpg)
Igbo asusu (Ibo)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice ibo sample ce notice ibo](/tpn/gen/sample-ce-notice-ibo.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement ibo sample ce statement ibo](/tpn/gen/sample-ce-statement-ibo.jpg)
èdè Yorùbá (Yoruba)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice yourba sample ce notice yourba](/tpn/gen/sample-ce-notice-yourba.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement yourba sample ce statement yourba](/tpn/gen/sample-ce-statement-yourba.jpg)
Lokaiahn Pohnpei (Pohnpeian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice pohnpeian sample ce notice pohnpeian](/tpn/gen/sample-ce-notice-pohnpeian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement pohnpeian sample ce statement pohnpeian](/tpn/gen/sample-ce-statement-pohnpeian.jpg)
Deitsch (Pennsylvania Dutch)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice pennsylvania dutch sample ce notice pennsylvania dutch](/tpn/gen/sample-ce-notice-pennsylvania-dutch.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement pennslyvania dutch sample ce statement pennslyvania dutch](/tpn/gen/sample-ce-statement-pennslyvania-dutch.jpg)
hoʻokomo ʻōlelo (Hawaiian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice hawaiian sample ce notice hawaiian](/tpn/gen/sample-ce-notice-hawaiian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement hawaiian sample ce statement hawaiian](/tpn/gen/sample-ce-statement-hawaiian.jpg)
Adamawa (Fulfulde)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice fulfulde sample ce notice fulfulde](/tpn/gen/sample-ce-notice-fulfulde.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement fulfulde sample ce statement fulfulde](/tpn/gen/sample-ce-statement-fulfulde.jpg)
tsalagi gawonihisdi (Cherokee)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice cherokee sample ce notice cherokee](/tpn/gen/sample-ce-notice-cherokee.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement cherokee sample ce statement cherokee](/tpn/gen/sample-ce-statement-cherokee.jpg)
I linguahén Chamoru (Chamorro)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice chamorro sample ce notice chamorro](/tpn/gen/sample-ce-notice-chamorro.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement chamorro sample ce statement chamorro](/tpn/gen/sample-ce-statement-chamorro.jpg)
ܣܘܼܪܸܬ݂ (Assyrian)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice assyrian sample ce notice assyrian](/tpn/gen/sample-ce-notice-assyrian.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement assyrian sample ce statement assyrian](/tpn/gen/sample-ce-statement-assyrian.jpg)
(Burmese)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice burmese sample ce notice burmese](/tpn/gen/sample-ce-notice-burmese.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement burmese sample ce statement burmese](/tpn/gen/sample-ce-statement-burmese.jpg)
Diné Bizaad (Navajo)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice navajo sample ce notice navajo](/tpn/gen/sample-ce-notice-navajo.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement navajo sample ce statement navajo](/tpn/gen/sample-ce-statement-navajo.jpg)
(Bassa)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice bassa sample ce notice bassa](/tpn/gen/sample-ce-notice-bassa.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement bassa sample ce statement bassa](/tpn/gen/sample-ce-statement-bassa.jpg)
Chahta (Choctaw)
» Notice of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce notice choctow sample ce notice choctow](/tpn/gen/sample-ce-notice-choctow.jpg)
» Statement of Nondiscrimination
[Name of covered entity] |
Summit Dental - William Samson DDS |
[Mailing address] |
REPLACE: Civil Rights Coordinator Mailing Address |
[Telephone number] |
REPLACE: Civil Rights Coordinator PHONE |
[TTY number—if covered entity has one] |
REPLACE: Civil Rights Coordinator TTYPHONE |
[FAX] |
REPLACE: Civil Rights Coordinator FAX |
[Email] |
REPLACE: Civil Rights Coordinator EMAIL |
[Name of civil rights coordinator] |
REPLACE: Civil Rights Coordinator |
[Name and Title of Civil Rights Coordinator] |
REPLACE: Name And Title Of Civil Rights Coordinator |
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
http://www.hhs.gov/ocr/office/file/index.html
![sample ce statement choctow sample ce statement choctow](/tpn/gen/sample-ce-statement-choctow.jpg)
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