Form: HIPAA Complaints

HIPAA Complaints Form

Filing a complaint with LivNao is voluntary. However, without the information requested below, we may not be able to proceed with your complaint. We will use the information you provide to determine if we have jurisdiction and, if so, how we will process your complaint. Information submitted on this form is confidential and is protected under the provisions of the Privacy Act of 1974. Names or other identifying information about individuals are disclosed when it is necessary for investigation of possible health information privacy violations, for internal systems operations, or for routine uses, which include disclosure of information outside of LivNao for purposes associated with health information privacy compliance and as permitted by law. It is illegal for a covered entity to intimidate, threated, coerce, discriminate or retaliate against you for filing this complaint or for taking any other action to enforce your rights under the Privacy Rule. You are not required to use this form and may write a letter to submit a complaint with the same information.