[PRACTICE LEGAL NAME / DBA]

Language Assistance and Auxiliary Aids Notice

Effective Date: [EFFECTIVE DATE]
FREE LANGUAGE ASSISTANCE SERVICES AND APPROPRIATE AUXILIARY AIDS AND SERVICES ARE AVAILABLE.

If English is not your primary language, or if you need information in an accessible format, tell a staff member or contact the practice. Qualified language assistance and appropriate auxiliary aids and services are provided free of charge when necessary for meaningful access and effective communication.

Language Assistance

  • Qualified spoken-language interpreters
  • Video remote and over-the-phone interpretation, when appropriate
  • Translated written information when required
  • Qualified bilingual or multilingual assistance when appropriate

Accessibility Assistance

  • Qualified American Sign Language interpreters
  • Certified Deaf Interpreter services when appropriate
  • Large print, audio, and accessible electronic formats
  • Other reasonable modifications and auxiliary aids

Interpreter Services Through Jeenie

Language Services Partner

[INTERPRETER PROVIDER]

The practice uses [INTERPRETER PROVIDER] to help arrange qualified interpretation services. The service provides access to more than 300 spoken and signed languages, including common, rare, and Indigenous languages, American Sign Language, and Certified Deaf Interpreter services.

Interpreter availability may vary. Some rare, Indigenous, and signed languages may require advance scheduling. Contact the practice as early as possible when requesting a specific language, dialect, or communication accommodation.

How to arrange an interpreter: Contact the practice using the information below. The practice will coordinate the interpreter. Patients should not be required to locate, provide, or pay for their own interpreter when the practice is legally required to provide language assistance.

Request Free Assistance

Telephone [LANGUAGE PHONE]
Email [LANGUAGE EMAIL]
TTY / Relay [TTY NUMBER]

When contacting the practice, identify the language, dialect, sign language, accessible format, or auxiliary aid needed. Whenever possible, provide advance notice for scheduled visits so the practice can coordinate the requested service.

Notice in Other Languages

This universal notice set intentionally includes the combined language coverage identified across the federal state-by-state language lists, together with additional languages that may move into or out of state top-language lists over time. The same master notice is used for every practice website to reduce the risk of omitting a required language.

Free assistance: Call [LANGUAGE PHONE] (TTY: [TTY NUMBER]) or speak to your provider. The practice will coordinate interpretation through its language-services partner.
language notices are included in this universal module.

Interpreter and Translation Standards

When interpretation or translation is required, the practice uses qualified assistance that is accurate, timely, impartial, and protective of patient privacy and independent decision-making. The practice generally will not require a patient to rely on minor children, family members, friends, or unqualified staff as interpreters, except in limited circumstances permitted by law.

Written translations and website notices. Interpreter availability through [INTERPRETER PROVIDER] supports live communication but does not replace legally required translated notices, vital documents, or written information. The practice provides translated notices and materials as required by applicable law.