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 Xxxxx Xxxxxxx, M.D. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 4 contracts
Samples: Confidentiality Agreement, Practice Policies and Agreement, Confidentiality 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 Xxxxx Xxxxxxx, M.D. All complaints must be submitted in writing. You will not be penalized for filing a complaint.contact:
Appears in 3 contracts
Samples: 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 Xxxxx XxxxxxxCompliance Officer, M.D. , J&R MEDICAL, 0000 XXXXXXXX XX., XXXXX 000 XXXXXXXX, XX 00000. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 2 contracts
Samples: 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 Xxxxx Xxxxxxx, 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
Samples: Concierge Medical 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, Wheelers Medical Supply LLC, 00000 Xxxxx XxxxxxxXxxx Xxx 000 X, M.D. Xxxxxxxxxxxx, XX 00000 . All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 1 contract
Samples: 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 Xxxxx Xxxxxxx, 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
Samples: 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 Xxxxx XxxxxxxXxxxxx Xxxxxx at xxxxxx@xxxxxxxxxxxxxxxxxxxx.xxx, M.D. (000) 000-0000. 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 organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our practiceorganization, contact Compliance Officer, UltraVoice, Ltd., 00 Xxxxx XxxxxxxXxxxxxx Xxxxxx Xxxx, M.D. Xxxxx 00, Xxxxxxx Xxxxxx, XX 00000. All complaints must be submitted in writing. You will not be penalized for filing a complaint. 7.
Appears in 1 contract
Samples: Customer Information Checklist
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, UltraVoice, Ltd., 00 Xxxxx XxxxxxxXxxxxxx Xxxxxx Xxxx, M.D. Xxxxx 00, Xxxxxxx Xxxxxx, XX 00000. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Appears in 1 contract
Samples: Customer Information Agreement
