AUXILIARY AIDS AND SERVICES FOR PERSONS WITH DISABILITIES POLICY: (Insert name of your facility) will take appropriate steps to ensure that persons with disabilities, including persons who are deaf, hard of hearing, or blind, or who have other sensory or manual impairments, have an equal opportunity to participate in our services, activities, programs and other benefits. The procedures outlined below are intended to ensure effective communication with patients/clients involving their medical conditions, treatment, services and benefits. The procedures also apply to, among other types of communication, communication of information contained in important documents, including waivers of rights, consent to treatment forms, financial and insurance benefits forms, etc. (include those documents applicable to your facility). All necessary auxiliary aids and services shall be provided without cost to the person being served. All staff will be provided written notice of this policy and procedure, and staff that may have direct contact with individuals with disabilities will be trained in effective communication techniques, including the effective use of interpreters. PROCEDURES: 1. Identification and assessment of need: (Name of facility) provides notice of the availability of and procedure for requesting auxiliary aids and services through notices in our (brochures, handbooks, letters, print/radio /televison advertisements, etc.) and through notices posted (in waiting rooms, lobbies, etc.).When an individual self-identifies as a person with a disability that affects the ability to communicate or to access or manipulate written materials or requests an auxiliary aid or service, staff will consult with the individual to determine what aids or services are necessary to provide effective communication in particular situations. 2. Provision of Auxiliary Aids and Services: (Insert name of your facility) shall provide the following services or aids to achieve effective communication with persons with disabilities: A. For Persons Who Are Deaf or Hard of Hearing (i) For persons who are deaf/hard of hearing and who use sign language as their primary means of communication, the (identify responsible staff person or position with a telephone number) is responsible for providing effective interpretation or arranging for a qualified interpreter when needed. In the event that an interpreter is needed, the (identify responsible staff person) is responsible for: Maintaining a list of qualified interpreters on staff showing their names, phone numbers, qualifications and hours of availability (provide the list); Contacting the appropriate interpreter on staff to interpret, if one is available and qualified to interpret; or Obtaining an outside interpreter if a qualified interpreter on staff is not available. (Identify the agency(s) name with whom you have contracted or made arrangements) has agreed to provide interpreter services. The agency’s/agencies’ telephone number(s) is/are (insert number(s) and the hours of availability). Note: If video interpreter services are provided via computer, the procedures for accessing the service must be included. (ii) Communicating by Telephone with Persons Who Are Deaf or Hard of Hearing [Listed below are three methods for communicating over the telephone with persons who are deaf/hard of hearing. Select the method(s) to incorporate in your policy that best applies/apply to your facility.] (Insert name of facility) utilizes a Telecommunication Device for the Deaf (TDD) for external communication. The telephone number for the TDD is (insert number). The TDD and instructions on how to operate it are located (insert location) in the facility; OR (Insert name of provider) has made arrangements to share a TDD. When it is determined by staff that a TDD is needed, we contact (identify the entity e.g., library, school or university, provide address and telephone numbers); OR (Insert name of facility) utilizes relay services for external telephone with TTY users. We accept and make calls through a relay service. The state relay service number is (insert telephone for your State Relay). (iii) For the following auxiliary aids and services, staff will contact (responsible staff person or position and telephone number), who is responsible to provide the aids and services in a timely manner: Note-takers; computer-aided transcription services; telephone handset amplifiers; written copies of oral announcements; assistive listening devices; assistive listening systems; telephones compatible with hearing aids; closed caption decoders; open and closed captioning; telecommunications devices for deaf persons (TDDs); videotext displays; or other effective methods that help make aurally delivered materials available to individuals who are deaf or hard of hearing. (iv) Some persons who are deaf or hard of hearing may prefer or request to use a family member or friend as an interpreter. However, family members or friends of the person will not be used as interpreters unless specifically requested by that individual and after an offer of an interpreter at no charge to the person has been made by the facility. Such an offer and the response will be documented in the person’s file. If the person chooses to use a family member or friend as an interpreter, issues of competency of interpretation, confidentiality, privacy and conflict of interest will be considered. If the family member or friend is not competent or appropriate for any of these reasons, competent interpreter services will be provided. NOTE: Children and other residents will not be used to interpret, in order to ensure confidentiality of information and accurate communication. B. For Persons Who are Blind or Who Have Low Vision (i) Staff will communicate information contained in written materials concerning treatment, benefits, services, waivers of rights, and consent to treatment forms by reading out loud and explaining these forms to persons who are blind or who have low vision [in addition to reading, this section should tell what other aids are available, where they are located, and how they are used]. The following types of large print, taped, Braille, and electronically formatted materials are available: (description of the materials available). These materials may be obtained by calling (name or position and telephone number). (ii) For the following auxiliary aids and services, staff will contact (responsible staff person or position and telephone number), who is responsible to provide the aids and services in a timely manner: Qualified readers; reformatting into large print; taping or recording of print materials not available in alternate format; or other effective methods that help make visually delivered materials available to individuals who are blind or who have low vision. In addition, staff are available to assist persons who are blind or who have low vision in filling out forms and in otherwise providing information in a written format. C. For Persons With Speech Impairments To ensure effective communication with persons with speech impairments, staff will contact (responsible staff person or position and telephone number), who is responsible to provide the aids and services in a timely manner: Writing materials; typewriters; TDDs; computers; flashcards; alphabet boards; communication boards; (include those aids applicable to your facility) and other communication aids. D. For Persons With Manual Impairments Staff will assist those who have difficulty in manipulating print materials by holding the materials and turning pages as needed, or by providing one or more of the following: Note-takers; computer-aided transcription services; speaker phones; or other effective methods that help to ensure effective communication by individuals with manual impairments. For these and other auxiliary aids and services, staff will contact (responsible staff person or position and telephone number) who is responsible to provide the aids and services in a timely manner.