Fillable Health Information Privacy Complaint Form - HIPAA News . org - hipaanews
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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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