(A) Filing HIPAA complaints. Any privacy related complaint made by a patient, employee or volunteer at anytime must be forwarded to the Privacy Officer. Complaints may also be made anonymously by calling the Privacy Officer. A complaint form is included within this section.
(B) Investigation of complaints.
(1) The department will investigate alleged privacy violations and complaints made by patients regarding alleged breaches of their privacy. Employees and workforce members may be requested to assist in investigations regarding complaints made by patients and other employees who believe fellow employees have violated patient privacy standards.
(2) Simultaneously, the department will undertake an investigation to determine if a breach of privacy has occurred. Any employee or workforce member found to be in violation of this policy or breaches the confidentiality of a patient's protected health information will be subject to disciplinary action, up to and including termination or dismissal.
(C) Complaint form.
Complaint Form
Romeoville Fire Department/Village of Romeoville
18 Montrose Drive, Romeoville, Illinois 60446
815-886-7227
As required by the Health Information Portability and Accountability Act of 1996 you have a right to complain about our privacy policies, procedures or actions. We will not engage in any discriminatory or other retaliatory behavior against you because of this complaint. Please be as thorough and forthright as possible.
Please complete the sections below:
Name: |
Address: |
Phone: |
Email Address: |
What is the best way to reach you? |
What are the best hours to reach you? |
Details of your complaint: (Please be as specific as possible with dates, times and the specific policy, procedure or action taken; include the names, if any, of any one in the office with whom you discussed this. Use the other side of this form if you need more room.)
Signature Date
This section is to be completed by the reviewer:
Date received: | Reviewed by: |
Chief Privacy Officer: | Review Date: |
Reviewer’s Comments:
(Ord. 0030-03, passed 4-2-03)