DescriptionSaving, Retrieving or Emailing your data can only be done with the full version of the Adobe Acrobat or the Adobe Approval and not with the free Adobe Reader. Form Approved: OMB No. 0990-0269. See OMB Statement on Reverse. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE FOR CIVIL RIGHTS (OCR) HEALTH INFORMATION PRIVACY COMPLAINT If you have questions about this form, call OCR (toll-free) at: 1-800-368-1019 (any...
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