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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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Include the following in your complaint letter: Your name, address and telephone number. The name, address, and telephone number of your attorney or authorized representative, if you are represented. The basis of your complaint. The date(s) that the incident(s) you are reporting as discrimination occurred.
Discrimination in health care is defined as negative actions or lack of consideration directed towards an individual or group based on preconceived notions about their identity. Individuals do not have to belong to a marginalized group themselves to experience discrimination against that group.
For example, in a disability or race discrimination case, some courts have said that the 4 elements are that (1) the plaintiff belongs to a protected group, (2) he is qualified for the job (3) the plaintiff was discriminated against, and (4) the plaintiff was replaced bv a nonminority.
To "discriminate" against someone means to treat that person differently, or less favorably, for some reason. Discrimination can occur while you are at school, at work, or in a public place, such as a mall or subway station.
Age. Age discrimination involves treating someone (an applicant or employee) less favorably because of age. Disability. Genetic Information. Unlawful Workplace Harassment (Harassment) ... National Origin. Pregnancy. Race/Color. Religion.
Direct evidence often involves a statement from a decision-maker that expresses a discriminatory motive. Direct evidence can also include express or admitted classifications, in which a recipient explicitly distributes benefits or burdens based on race, color, or national origin.
Strategies for Combatting Racism in Health Care Examining institutional policies with an equity lens. Establishing accountability frameworks such as equity scorecards. Auditing medical school curricula for erroneous references to race. Reviewing clinical algorithms that erroneously rely on race.
Index of Discrimination:This is the difference between the percent of correct responses in the upper group and the percent of correct responses in the lower group. Maximum Discrimination: This is the sum of the percent in the upper and lower groups marking the item correctly.
If you've experienced unlawful discrimination, you can complain to the person or organisation who's discriminated against you. You can also make a discrimination claim in the civil courts.