Appendix A to Part 88 - Model Text: Notice of Rights Under Federal Conscience and Anti-Discrimination Laws
45:1.0.1.1.47.0.47.11.30 : Appendix A
Appendix A to Part 88 - Model Text: Notice of Rights Under Federal
Conscience and Anti-Discrimination Laws
[Name of recipient, the Department, or Department component]
complies with applicable Federal conscience and anti-discrimination
laws prohibiting exclusion, adverse treatment, coercion, or other
discrimination against individuals or entities on the basis of
their religious beliefs or moral convictions. You may have the
right under Federal law to decline to perform, assist in the
performance of, refer for, undergo, or pay for certain health
care-related treatments, research, or services (such as abortion or
assisted suicide, among others) that violate your conscience,
religious beliefs, or moral convictions.
If you believe that [Name of recipient, the Department, or
Department component] has failed to accommodate your conscientious,
religious, or moral objection, or has discriminated against you on
those grounds, you can file a conscience and religious freedom
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, DC
20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms and more
information about Federal conscience and anti-discrimination laws
are available at http://www.hhs.gov/conscience.