Nevada 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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FAQ
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.
If you have any questions about how HIPAA does or does not apply to your situation, or to make a complaint, please call the Privacy Officer, Cynthia Birney, at (702) 455-3269. Callers may remain anonymous if they choose.
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.
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?
If the review identifies a potential HIPAA violation, it will be investigated further. An investigation can result in several outcomes. If no violation is identified, you should receive a communication explaining why. If a minor violation is identified, the organization will likely take steps to rectify it.
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 may complain to us or to the Secretary of Health and Human Services (HHS) if you believe your privacy rights have been violated by us. You may also call the Compliance Specialist/Privacy Officer at (702) 759-1609 or email compliancespecialist@snhd.org for further information about the complaint process.
