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 concerns about your privacy rights, I 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 the U.S. Department of Health and Human Services. I will provide you with this address upon your request.

Appears in 1 contract

Samples: Psychotherapist Patient Services Agreement

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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, I will be more than willing to discuss these concerns. 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 me/my officecomplaint, you please do so in writing. You may also send your a written complaint to the Secretary of the U.S. Department of Health and Human Services. Upon request I will provide you with this address upon the appropriate address. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your requestright 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, I will be more than willing to discuss these concernsyou may contact me. 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 will can provide you with this the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your requestright to file a complaint.

Appears in 1 contract

Samples: Suzanne Miller

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, I will be more than willing to you may contact me and we can discuss these concernsthis. 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. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I will can provide you with this the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your requestright to file a complaint.

Appears in 1 contract

Samples: 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, I will be more than willing to discuss these concernsplease contact me at my office. 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. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I will can provide you with this the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your requestright to file a complaint.

Appears in 1 contract

Samples: Patient Services Agreement

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