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 Xxxx X. Xxxxxx, Ph.D. at 000-000-0000. If you believe that your privacy rights have been violated and wish to file a complaint with my office, you may send your written complaint to Xxxx X. Xxxxxx, Ph.D., 0000 Xxxxxxx Xxxxxxx, Xxxxx X, Xxxxxxxxx, XX 00000. You may also send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights. You have specific rights under the Privacy Rule and I will not retaliate against you for exercising the right to file a complaint.
Appears in 2 contracts
Samples: General Information and Psychological Services Agreement, General Information and Psychological Services Agreement
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 Xxxx X. Xxxxxx, Ph.D. me at 000-000-0000. If you believe that your privacy rights have been violated and wish to file a complaint with my officeme, you may send your written complaint to Xxxx X. Xxxxxx, Ph.D., me at 0000 Xxxxxxx XxxxxxxXxxxxx Xx., Xxxxx XXxxxx, XxxxxxxxxXxxxxx, XX 00000, or via email at xxxxxxxxxxx@xxxxx.xxx. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights. I can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule and Rule. I will not retaliate against you for exercising the your right to file a complaint.
Appears in 1 contract
Samples: Services Agreement
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 Xxxx X. Xx Xxxxx, 0 Xxxxxxxxx Xxxxxx, Ph.D. at Xxxxx 000-000-0000, Xxxxxxxxx, XX 00000. • If you believe that your privacy rights have been violated and wish to file a complaint with my officeXx Xxxxx, you may send your written complaint to Xxxx X. Xx Xxxxx, 0 Xxxxxxxxx Xxxxxx, Ph.D., 0000 Xxxxxxx Xxxxxxx, Xxxxx X000, Xxxxxxxxx, XX 00000. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights. • You have specific rights under the Privacy Rule and Rule. I will not retaliate against you for exercising the your right to file a complaint.
Appears in 1 contract
Samples: Summary of Agreement