Ascension Wisconsin Hospital – Waukesha

Ascension Wisconsin Hospital
Patient & Visitor Notice of Non-Discrimination

As a recipient of Federal financial assistance, Ascension Wisconsin Hospital complies with all applicable laws, regulations, and policies related to non-discrimination, and does not discriminate, exclude, or otherwise treat individuals, patients, or visitors differently on the basis of race; ethnicity; familial status; ancestry; color; religion; sex; sexual orientation or preference; gender identity; national origin (including Limited English Proficiency); age; handicap or disability; genetic information; veteran status; or any other protected characteristic under applicable laws in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, including the assigning or transfers of patients to rooms, floors, and sections; assigning staff to patients; utilization of the health care facility; or granting staff privileges of professionally qualified personnel, whether carried out by Ascension Wisconsin Hospital directly or through a contractor or any other entity with which Ascension Wisconsin Hospital arranges to carry out its programs and activities.

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination act of 1975, Section 1557 of the Affordable Care Act (ACA), regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 Code of Federal Regulations Parts 80, 84, and 91, and applies to all patients, health care professionals and staff members of Ascension Wisconsin Hospital. Health care professionals include physicians, allied health professionals and other licensed health care professionals. Staff members include all employees, agency personnel, contractors, consultants, students, and volunteers.

Notice of Program Accessibility

Ascension Wisconsin Hospital and all its programs and activities are accessible to and usable by disabled persons, including persons who are deaf, hard of hearing, or blind, or who have other sensory impairments.

Ascension Wisconsin Hospital:

  • Provides people with disabilities reasonable modifications and free auxiliary aids and services to people with disabilities, or English proficiency to access Ascension Wisconsin Hospital and to communicate effectively with us, such as:
    • Qualified sign language interpreters, video remote interpreting or other aids for hearing impaired individuals
    • Written information in multiple formats including large print, audio, accessible electronic formats, or other formats for visually impaired individuals
  • Provides free language assistance services to people whose primary language is not English, which may include:
    • Qualified interpreters or a language line
    • Information written in other languages

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, please contact Ascension Wisconsin Hospital ADA/1557 Coordinator at 1-262-415-2001 (State Relay 7-1-1 or 1-800-947-6644).

Grievance Procedure:

If you believe that Ascension Wisconsin Hospital has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

ADA/1557 Coordinator
Ascension Wisconsin Hospital Menomonee Falls Campus
N88 W14275 Main St.
Menomonee Falls, WI 53051 Hospital Main Campus Number: 1-262-415-2001

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Ascension Wisconsin Hospital ADA/1557 Coordinator is available to help you.

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

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

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
This notice is available at Ascension Wisconsin Hospital’s website: https://ascensionwisconsinhospital.org

English: ATTENTION: If you speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-262-415-2001.

Spanish: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. También se dispone de ayuda y servicios auxiliares adecuados para proporcionar información en formatos accesibles. Llame al 1-262-415-2001.

Vietnamese: CHÚ Ý: Nếu bạn nói tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ miễn phí có sẵn cho bạn. Các hỗ trợ và dịch vụ phụ trợ thích hợp để cung cấp thông tin ở các định dạng có thể truy cập cũng có sẵn miễn phí. Gọi 1-262-415-2001.

Chinese: 谨按:若曰 [插语],可得免费语助事。 免费佐设备服务,以无障碍式给信息。 致电 1-262-415-2001。

Korean: 주의: 한국어를 구사할 수 있다면 무료 언어 지원 서비스를 이용할 수 있습니다. 접근 가능한 형식으로 정보를 제공하기 위한 적절한 보조 도구 및 서비스도 무료로 제공됩니다 1-262-415-2001로 전화하십시오.

Arabic: بأشكال المعلومات لتوفیر مناسب ة مساعدة وخدمات مساعدات مجانا تتوفر كما .لك متاحة المجانیة اللغویة المساعدة خدمات فإن ، العربیة تتحدث كنت إذا :تنبیھ 1-262-415-2001 بالرقم اتصل .إلیھا الوصول یسھل .

French: ATTENTION : Si vous parlez français, des services d’assistance linguistique gratuits sont à votre disposition. Des aides et des services auxiliaires appropriés pour fournir de l’information dans des formats accessibles sont également disponibles gratuitement. Composez le 1-262-415-2001.

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachhilfen zur Verfügung. Entsprechende Hilfsmittel und Dienste zur Bereitstellung von Informationen in barrierefreien Formaten stehen ebenfalls kostenlos zur Verfügung. Rufen Sie 1-262-415-2001 an.

Russian: ВНИМАНИЕ: Если вы владеете русским языком, вам доступны бесплатные услуги языковой помощи. Также на безвозмездной основе предоставляются соответствующие вспомогательные средства и услуги по предоставлению информации в доступных форматах. Звоните по номеру 1-262-415-2001.

Pennsylvania Dutch: 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 1-262-415-2001.

Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-262-415-2001.

Hmong: XIM: Yog hais tias koj hais lus Hmong, dawb pab dawb rau koj. Tsim nyog auxiliary aids thiab cov kev pab cuam muab cov ntaub ntawv nyob rau hauv cov ntaub ntawv siv los mus siv. Hu rau 1-262-415-2001.

Laotian: ຄວາມສົນໃຈ: ຖ້າທ່ານເວົ້າພາສາລາວ, ທ່ານສາມາດບໍລິການຊ່ວຍເຫຼືອພາສາໂດຍບໍ່ຕ້ອງເສຍຄ່າ. ນອກຈາກນັ້ນ ຍັງມີການຊ່ວຍເຫລືອ ແລະ ບໍລິການຊ່ວຍເຫຼືອທີ່ເຫມາະສົມເພື່ອໃຫ້ຂໍ້ມູນໃນຮູບແບບທີ່ເຂົ້າເຖິງໄດ້ໂດຍບໍ່ຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍ. ໂທ ຫາ 1-262-415-2001.

Hindi: 􀈯ान दें: यिद आप [भाषा डालें] बोलते हैं, तो आपके िलए मु􀉞 भाषा सहायता सेवाएं उपल􀉩 हैं। सुलभ प्रारूपों में जानकारी प्रदान करने के िलए उपयु􀆅 सहायक सहायता और सेवाएं भी िन: शु􀊋 उपल􀉩 हैं। 1-262-415-2001 पर कॉल करें।

Albanian: KUJDES: Nëse flisni [fut gjuhën], shërbimet e ndihmës gjuhësore falas janë në dispozicionin tuaj. Ndihmat dhe shërbimet ndihmëse të përshtatshme për të dhënë informacion në formate të arritshme janë gjithashtu në dispozicion falas. Telefononi në 1-262-415-2001.

Tagalog: PAALALA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga libreng serbisyong tulong sa wika. Magagamit din nang libre ang mga naaangkop na auxiliary na tulong at serbisyo upang magbigay ng impormasyon sa mga naa-access na format. Tumawag sa 1-262-415-2001.