Louisiana Health Information Privacy Complaint Form for filing with HIPAA Privacy Office

State:
Multi-State
Control #:
US-354EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used to initiate a complaint based on a violation of the HIPPA laws.

How to fill out Health Information Privacy Complaint Form For Filing With HIPAA Privacy Office?

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FAQ

HIPAA privacy violations can be reported to the HHS Office for Civil Rights by sending an email to the OCR complaint portal at OCRCompliance@hhs.gov.

You can report a HIPAA violation by various channels regardless of whether you are a member of a Covered Entity´s workforce or a patient/plan member. These channels include the Privacy Officer at the organization where the violation occurred, your State Attorney General, and HHS' Office for Civil Rights.

Your complaint must: Be filed in writing: sent by mail, fax or e-mail. Name the person that is the subject of the complaint and describe the act or acts believed to be in violation of the Patient Safety Act requirement to keep PSWP confidential.

HIPAA Breach Notification Rule. Not all HIPAA violations are required to be reported to the relevant patient or HHS. Under the breach notification rule, covered entities are only required to self-report if there is a ?breach? of ?unsecured? PHI. (45 CFR § 164.400 et seq.).

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How long do you have to report a HIPAA violation and is it necessary to report violations of HIPAA within 180 days? You have 180 days to report a HIPAA violation to HHS´ Office for Civil Rights (OCR), but timeframes can differ if you wish to report a HIPAA violation to a covered entity or a state Attorney General.

If 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.

Anyone can make a complaint or report a HIPAA violation anonymously. It should be noted, however, that the OCR has stated that they will not commence an investigation into a covered entity unless the complainant is named and has provided contact details.

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Louisiana Health Information Privacy Complaint Form for filing with HIPAA Privacy Office