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How to File a Health Information Privacy Complaint

 HIPAA and the Agency of Human Services

 HOW TO FILE A HEALTH INFORMATION PRIVACY COMPLAINT

If you believe that the Agency of Human Services (AHS) or any of its divisions or departments has violated yours or someone else’s health information privacy rights, you may file a complaint with the AHS Privacy Officer. 

 You may also file a complaint with the Office for Civil Rights.  Please refer to the AHS Notice of Privacy Practices for information on how to do so.  You can find the AHS Notice of Privacy Practices on this website or you can request a paper copy by calling 802-241-2234.

 You will not be retaliated for filing a complaint.  Benefits or services that you receive will not be affected by any complaint that you make to the Privacy Officer or to the Office for Civil Rights.

To file a complaint with the AHS Privacy Officer:

 1. You can file a complaint with the AHS Privacy Officer by mail, fax, or email.  You can submit your complaint in any written format. 

2. We recommend that you use the AHS Health Information Privacy Complaint Form

3. If you prefer you may submit your written complaint in your own format.

Be sure to include the following information:

  •  Your name, address, telephone number or email address.
  •  If you are filing the complaint on someone else’s behalf, please provide the person’s name on behalf of whom you are filing the complaint.
  •  Name, address, and phone of the person or AHS department, division, or district office you believe violated your or someone else’s health information privacy rights or committed another violation of the Privacy Rule.
  • Describe what happened.  Answer “How, why, and when do you believe your or someone else’s privacy rights were violated or the Privacy Rule was otherwise violated?”
  •  Please include any other information you believe to be relevant.
  •  Please sign your name and date your complaint.

If you need help filing a complaint or have questions please call the Privacy Officer at 802-241-2234.