HIPAANEWS
Saving, 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 language) or 1-800-537-7697 (TDD) YOUR FIRST NAME YOUR LAST NAME HOME PHONE WORK PHONE ( ) ( ) CITY STREET MoreOFFICE FOR CIVIL RIGHTS (OCR). HEALTH INFORMATION PRIVACY COMPLAINT. If you have questions about this form, call OCR (toll-free) at: ... Less
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