New Jersey Health Information Privacy Complaint Form for filing with HIPAA Privacy Office
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How to fill out Health Information Privacy Complaint Form For Filing With HIPAA Privacy Office?
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Both the HIPAA Privacy Rule and New Jersey law give you rights to your medical record. The HIPAA Privacy Rule sets standards that apply to records held by health care providers across the nation. New Jersey law sets standards for records held by health care providers within the state.
If you are willing to provide your name and contact information, use this online form to file a complaint about the care you received at a licensed health care facility in New Jersey. If you prefer to remain anonymous, you may still file a complaint by calling the Department of Health Complaint Hotline at 800-792-9770.
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.
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.
You may file a health information privacy and security complaint with the Office for Civil Rights (OCR) if you feel a covered entity or business associate violated your (or someone else's) health information privacy rights or committed another violation of the Privacy, Security or Breach Notification Rules.
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 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.
To 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?
