Discrimination is Against the Law

Big Sky Surgery Center (“BSSC”) complies with applicable Federal civil rights laws and does
not discriminate on the basis of race, color, national origin, age, disability, or sex. BSSC does
not exclude people or treat them differently because of race, color, national origin, age,
disability, or sex.

BSSC 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)

BSSC provides free language services to people whose primary language is not English, such as information written in other languages. If you need these services, contact BSSC’s Civil Rights Coordinator.

If you believe that BSSC 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:

• Jodi Carter, Clinical Director @ Big Sky Surgery Center
• Mailing Address: 2833 Fort Missoula Rd, Missoula, MT 59804
• Telephone Number: (406) 542-6559
• Fax: (406) 542-9040
• Email: jodi@bigskysurgery.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, BSSC’s Civil Rights 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, 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 https://www.hhs.gov/ocr/office/file/index.html.