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Covered entity name or associate involved and describe acts or omissions that you believe violated the terms of the privacy, security or notice of default rules. within 180 days after, if you knew that the Act or omission which allegedly took place. OCR may extend the period of 180 days, if you can demonstrate good cause. . . Should help to bring a complaint or inquiry about the complaint or forms have voices, OCR for email. After completing the consent form, you will be able to continue to print the report for your records. . (Please note that communication by unencrypted e-mail a danger, which may contain personally identifiable information email be intercepted by unauthorized third parties.). Call to complete and you (or someone else) considers that the Agency's telephone number, person or organization that violated health information privacy is truth or an obligation, another violation of the privacy or security rule. Summary of the above. How, when and why you believe your (or someone else's) health information privacy have been violated or is violating the privacy or security rule otherwise. If you appeal, even one on behalf of a person, in how to read a man file order to undertake. The following information is optional: If your email or call, don't forget to send the appropriate regional office based where the alleged violation took place fax OCR. OCR has ten regional offices, and each regional office covers specific States. Send your complaint to the attention of the OCR Regional Manager. You don't have to votes to sign the complaint and shapes, when you send an email, because their study represents the shipment via email. . . . . .