Fillable HIPAA Privacy Complaint Report (Cameron University)

Fill Online, Printable, Fillable, Blank HIPAA Privacy Complaint Report (Cameron University) Form

Use Fill to complete blank online CAMERON UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

HIPAA Privacy Complaint Report (Cameron University)

On average this form takes 2 minutes to complete

The HIPAA Privacy Complaint Report (Cameron University) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Cameron University

BROWSE CAMERON UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Cameron University
Health Plan
HIPAA
Privacy Complaint Report
Reported by: Date:
Contact Information:
Email Address: Telephone Number:
Statement of Complaint:
Date of Occurrence:
Location of Occurrence:
Individuals filing a complaint may submit this form to the Employee Health Plan or to the University Privacy Official by
email: OUCompliance@ouhsc.edu; fax: (405) 271-5545; or mail to: University of Oklahoma Privacy Official, P O Box 26901, Oklahoma
City, OK 73190.
Individuals may also contact the Secretary of Health and Human Services Office of Civil Rights – DHHS, 1301 Young Street, Suite 1169,
Dallas TX, 75202, (214) 767-4066; (214) 767-8940 TDD.
HIPAA Document
Rev.1/2015 © 2015 Retain in Department Files
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

HIPAA Privacy Complaint Report (Cameron University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document