Notice of Nondiscrimination
This practice serves all patients regardless of inability to pay.
Discounts for essential services are offered based on family size and income.
For more information contact our office.
North Florida Pediatrics complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. North Florida Pediatrics does not exclude people or treat people differently because of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.
North Florida Pediatrics:
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, or 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, please contact us at our office.
Should you believe that North Florida Pediatrics has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may file a grievance toward:
Samuel Santelices, M.D.
1859 SW Newland Way
Lake City, FL 32025
Phone: (386) 758-0003, (TTY (386) 758-0003)
Fax: (386) 755-4432
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, we are 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