Guam Health Information Privacy Complaint Form for filing with HIPAA Privacy Office
Description
How to fill out Health Information Privacy Complaint Form For Filing With HIPAA Privacy Office?
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FAQ
U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is responsible for enforcing the HIPAA Privacy and Security Rules.
Hear this out loud PauseTo submit an electronic complaint, go to OCR's Web site at: .hhs.gov/ocr/privacy/hipaa/complaints/index.html. To submit a complaint using alternative methods, see reverse page (page 2 of the complaint form). When do you believe that the violation of health information privacy rights occurred?
Filing a Complaint If you believe that a HIPAA-covered entity or its business associate violated your (or someone else's) health information privacy rights or committed another violation of the Privacy, Security, or Breach Notification Rules, you may file a complaint with the Office for Civil Rights (OCR).
WHAT IS A PRIVACY BREACH? A privacy breach occurs when Ontario's Personal Health Information Protection Act (PHIPA) has been contravened, for example, where personal health information is stolen, lost or if it is used or disclosed without authority.
Your complaint must: Be filed in writing by mail, fax, e-mail, or via the OCR Complaint Portal. Name the covered entity or business associate involved, and describe the acts or omissions, you believed violated the requirements of the Privacy, Security, or Breach Notification Rules.
Hear this out loud PauseIf you suspect a violation of your HIPAA privacy rights, you can report it anonymously. You may do so by calling 1-866-633-6472, or filling out this complaint form.
Call your local police department immediately. Report your situation and the potential risk for identity theft. The sooner law enforcement learns about the theft, the more effective they can be.
Hear this out loud PauseFiling a Complaint If you believe that a HIPAA-covered entity or its business associate violated your (or someone else's) health information privacy rights or committed another violation of the Privacy, Security, or Breach Notification Rules, you may file a complaint with the Office for Civil Rights (OCR).
