jǔ ké m̀ dyiɛ jǎà po kà [Name of covered entity] se m̀ gbo kpáa Ɔ ɓɛ́ ɖé ɖɛ ɓěɛ̀ mú, mɔɔ ké wa ge nyɔǔn-dyù mú hwìè ko-kò mú dyììn nyɔɔ̀ sɔ̀ mɔɔ kà ɖé ɓě ɖé ɓóɖó-dù nyɔɔ̀ nyu nìɛ̀ kɛ, mɔɔ nyɔɔ̀ sɔ̀ mɔɔ zɔ̃ jĩ̌ kà nyɔɔ̀ nyuɛ, mɔɔ ɓóɖó ɓɛ́ ɖǎ nyɔɔ̀ mɛ kɔ́ dyíɛ, mɔɔ nyɔɔ̀ mɛ mɔ̀ gàa, mɔɔ nyɔɔ̀ mɛ mɔ̀ màa kɛɛ múɛ, ké m̀ nì jè zaa dèɛ̀ [Name and Title of Civil Rights Coordinator], [Mailing ɓěɔ̀ ɖé Address], [Telephone number ], [TTY number—if covered entity has one], [Fax], [Email]. M̀ mìɔ-kpo nì cɛ̃ɛ mɔɔ m̀ wa mɔɔ m̀ [Name ɓěɔ̀ and Title of Civil Rights Coordinator]. jǔ ké m̀ dyi gbo-kpá-kpá mɔ́ m̀ ké nì tò ní, nìí, [Name and Ɔ ɓɛ́ ɓěɔ̀ Title of Civil Rights Coordinator] wa ké m̀ gbo kpá. ɓɛ́ Nyɔ dyi m̀ gbà bũ̌ nìí, m̀ jè zaa dèɛ̀ ɖò ɖɛ ɖò ɔ ɖé ɖé waà gbǒ Nyɔǔn-dyùɛ̀ Wɛ́ jè kè Nyɔǔn-dyù jè gboɛɛ gbo, mɔɔ gma ɖé nyɔǔn-dyù dyíɛ gbo. Céè wa gbo dyììn ɓěɔ̀ céè mɔɔ ɖé, ɖá: U S Department of Health and Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D. C. 20201 1-800-868-1019, 800-537-7697 9 (TDD) M̀ Zaa-dè-cèè-ɖɛ̀ dyéɛ http//www.hhs.gov/ocr/office/file/index html ɓěɔ̀
Ɔ jǔ ké m̀ dyiɛ jǎà po kà ɓɛ́ [Name of covered entity] se m̀ gbo kpáa ɖé ɖɛ ɓěɛ̀ mú, mɔɔ ké wa ge nyɔǔn-dyù mú ɖé hwìè ko-kò ɓě mú dyììn ɖé ɓóɖó-dù nyɔɔ̀ sɔ̀ mɔɔ kà nyɔɔ̀ nyu nìɛ̀ kɛ, mɔɔ ɓóɖó ɓɛ́ nyɔɔ̀ sɔ̀ mɔɔ zɔ̃ jĩ̌ kà nyɔɔ̀ ɖǎ nyuɛ, mɔɔ nyɔɔ̀ mɛ kɔ́ dyíɛ, mɔɔ nyɔɔ̀ mɛ mɔ̀ gàa, mɔɔ nyɔɔ̀ mɛ mɔ̀ màa kɛɛ múɛ, ké m̀ nì ɓěɔ̀ jè zaa dèɛ̀ ɖé [Name and Title of Civil Rights Coordinator], [Mailing Address], [Telephone number ], [TTY number—if covered entity has one], [Fax], [Email]. M̀ mìɔ-kpo nì ɓěɔ̀ cɛ̃ɛ mɔɔ m̀ wa mɔɔ m̀ [Name and Title of Civil Rights Coordinator]. Ɔ jǔ ké m̀ dyi gbo-kpá-kpá mɔ́ ɓɛ́ m̀ ké nì ɓěɔ̀ tò ní, nìí, [Name and Title of Civil Rights Coordinator] ɓɛ́ wa ké m̀ gbo kpá. Nyɔ ɖò dyi m̀ ɖɛ gbà ɖò bũ̌ nìí, m̀ ɔ jè zaa dèɛ̀ ɖé ɖé waà gbǒ Nyɔǔn-dyùɛ̀ Wɛ́ jè kè Nyɔǔn-dyù jè gboɛɛ gbo, mɔɔ ɖé gma nyɔǔn-dyù dyíɛ ɓěɔ̀ gbo. Céè wa gbo dyììn ɖé, céè mɔɔ ɖá: U S Department of Health and Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D. C. 20201 1-800-868-1019, 800-537-7697 9 (TDD) M̀ Zaa-dè-cèè-ɖɛ̀ ɓěɔ̀ dyéɛ http//www.hhs.gov/ocr/office/file/index html