Things You'll Need:
- Health Information Privacy Complaint Form
- Pen or Microsoft Word
- Printer
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Step 1
Click the link below to open the Privacy Complaint Form pdf. Download and save the form.
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Step 2
Open the form with Microsoft Word to fill your information or print out the form and fill it out with a pen.
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Step 3
Email the completed electronic form to OCRComplaint@hhs.gov. If you printed it out and filled it in you may send it to the regional office for your area. See link below for addresses.
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Step 4
Call OCR at 1-866-627-7748 if you need any help filling out the form. The call is toll-free.












