Common use of Questions and Complaints Clause in Contracts

Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me. If you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to me at the above address or by e-mail. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

Appears in 1 contract

Samples: Suzanne Miller

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Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me. If you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to me at the above address or by e-mailat: 0000 00xx Xxxxxx XX, Xxxxx 000, Xxxxxxxxxx, XX 00000. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I can provide you with the appropriate address upon request. You Please note: you have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

Appears in 1 contract

Samples: dralexafram.com

Questions and Complaints. If Now or in the future, if you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me. If you or believe that your privacy rights have been violated and please let me know as soon as possible. If you wish to file a complaint with mecomplaint, you may send your written complaint to me at the above address or by e-mailplease do so in writing. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Upon request I can will provide you with the appropriate address upon requestaddress. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

Appears in 1 contract

Samples: Please Complete And

Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact meI will be more than willing to discuss these concerns. If you believe that your privacy rights have been violated and wish to file a complaint with me/my office, you may send your written complaint to me at the above address or by e-mail. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I can will provide you with the appropriate this address upon your request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

Appears in 1 contract

Samples: Psychotherapist Patient Services Agreement

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Questions and Complaints. If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact meme and we can discuss this. If you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to me at the above address or by e-mailme. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.

Appears in 1 contract

Samples: Patient Services Agreement

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