Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 4 contracts
Sources: Confidentiality Agreement, Practice Policies and Agreement, Practice Policies and Agreement
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. All complaints must be submitted in writing. You will not be penalized for filing a complaint.contact:
Appears in 3 contracts
Sources: Direct Primary Care Patient Agreement, Direct Primary Care Patient Agreement, Patient Agreement
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our practiceorganization, contact ▇Compliance Officer, , J&R MEDICAL, ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇., M.D. ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 2 contracts
Sources: Authorization for Release of Information, Assignment of Benefits, Duplicate Equipment/Supplies, Authorization for Release of Information, Assignment of Benefits, Duplicate Equipment/Supplies
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. the “Privacy Officer” designated above. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 1 contract
Sources: Patient Agreement
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our my practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our my practice, contact ▇▇▇▇▇▇ ▇▇▇▇▇▇ at ▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇, M.D. (▇▇▇) ▇▇▇-▇▇▇▇. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 1 contract
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. Privacy Officer 404-257-5585. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 1 contract
Sources: Concierge Medical Agreement