Non-Discrimination Notice

Contact Good Samaritan With Concerns You May Have

At Good Samaritan, we want our staff, our patients, and our community to be confident in the integrity of our facility and decisions made to provide service. We proudly comply with all applicable Federal laws concerning discrimination and encourage those who feel as if discrimination has occurred to contact hospital management.

Click here to read our Non-discrimination notice as a PDF.

Non-discrimination Notice

Good Samaritan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, sex, national origin, disability, religion, age, sexual orientation or gender identity. Good Samaritan does not exclude people or treat them differently because of race, color, sex, national origin, disability, religion, age, sexual orientation or gender identity. A Sliding Fee Discount Program (Medically Indigent Program) is available to all patients regardless of ability to pay, and Good Samaritan does not discriminate against patients because payment for services is made under Medicare, Medicaid and CHIP.

Good Samaritan:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
○ Qualified sign language interpreters
○ Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:
○ Qualified interpreters
○ Information written in other languages

If you need these services, contact Social Services at 812-885-3308.

If you believe that Good Samaritan has failed to provide these services or discriminated in another way on the basis of race, color, sex, national origin, disability, religion, age, sexual orientation or gender identity, you can file a grievance with:

Wendy Mangin, Director of Corporate Compliance
520 S 7th Street, Vincennes, IN 47591
Phone: 812-885-3487; Fax: 812-885-3880
Email: wmangin@gshvin.org

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, please contact Wendy Mangin.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

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

Last Update: January 2020

Language Assistance

ATTENTION: If you speak English language assistance services, free of charge, are available to you. Call 1-812-885-3308 (TTD: 1-812-885-3850)

Spanish - Español ATENCIÓN: Si habla Español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-812-885-3308 (TTD: 1-812-885-3850).

Chinese - 中文 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-812-885-3308（TTD：1- 812-885-3850）

German - Deutsche ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-812-885-3308 (TTD: 1-812-885-3850).

Pennsylvania Dutch - Pennsilfaanisch Deitsch Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-812-885- 3308 (TTD: 1-812-885-3850).

Burmese - ျမန္မာ သတိျပဳရန္- အကယ္၍ သင္သည္ျမန္မာစကား ကို ေျပာပါက၊ ဘာသာစကား အကူအညီ၊ အခမဲ့၊ သင့္အတြက္စီစဥ္ေဆာင္ရြက္ေပးပါမည္။ ဖုန္းနံပါတ္1-812-885-3308 (TTD: 1-812-885-3850) သုိ႔ ေခၚဆိုပါ။ ال عرب ية -

Arabic ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم ) 3850-885-812-1) :TTD .)1-812-885-TTD) 3308: 1-812-885-3850(والبكم الصم هاتف رقم )1-812-885-3308

Korean - 한국인 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-812- 885-3308 (TTD: 1-812-885-3850)번으로 전화해 주십시오.

Vietnamese - Tiếng Việt CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-812-885-3308 (TTD: 1-812-885-3850).

French - Français ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-812-885-3308 (ATS : 1-812-885-3850).

Japanese - 日本語 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-812-885-3308（ TTD:1-812-885-3850）まで、お電話にてご連絡ください。

Dutch - Nederlands AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-812-885-3308 (TTD: 1-812-885-3850).

Tagalog - Filipino PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-812-885-3308 (TTD: 1-812-885-3850).

Russian - Pусский ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-812-885-3308 (телетайп: 1-812-885-3850).

Punjabi - ਪੰ ਜਾਬੀ ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਧਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1-812- 885-3308 (TTD: 1-812-885-3850) 'ਤੇ ਕਾਲ ਕਰੋ।

Hindi - ह िंदी ध्यान दें: यदद आप ह िंदी बोलते हैं तो आपके ललए मफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। ु 1-812- 885-3308 (TTD: 1-812-885-3850) पर कॉल करें।