It outlines your rights to privacy and the limitations.
*The information and signature forms will be sent to you along with the intake paperwork. If you have any questions about the information you are signing, please call me and we will go over your questions.
If you believe that your privacy rights have been violated, you have the right to file a complaint in writing with me or with the Office for Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building – Room 1875, Boston, Massachusetts 02203. Voice phone (617) 565-1340. Voice phone 443-805-6119. FAX (617) 565-3809. TDD (617) 565-1343.There is no retaliation against you for filing a complaint. The effective date of this Notice is September 30, 2010.