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Form Details...
| Form Title: | HIPAA Complaint Form |
| Last Revised: | 12/2005 |
| Purpose: | As required by the Health Information Portability and Accountability Act of 1996 (HIPAA) you have a right to complain about UCAR's privacy policies, procedures or actions. UCAR will not engage in any discriminatory or other retaliatory behavior against you because of this complaint. Please be as thorough and forthright as possible, and return it to UCAR's Contact Person listed on the form. |
| Who Should Use the Form: | Employee and Contact Person |
| Instructions: | The employee completes the Complaint Form (first tab), signs and submits to Laurie Carr (confidential internal mail to CG4 or fax 303-497-8701). |
| View the Form: | View a Blank Tab 1 Form in .pdf Format | Blank Tab 2 | Blank Tab 3 |
| Form Download Information | |
| File Format: | Excel 5.0 (.xls) |
| Download File: | Click Here to Download the Form! |
| Problems? Contact: | Laurie Carr, x8702 |
If you are having trouble downloading forms see HELP below.
webmaster@fanda.ucar.edu
Thank you!