You have the right to file a complaint about our privacy practices. You may file a complaint if you are dissatisfied with the content of our Notice of Privacy Practices or our Privacy Policies and Procedures. You may also file a complaint if you believe that we have failed to comply with the terms of our Privacy Policies and Procedures, or with any provision of federal or state law concerning the privacy of your health information or your rights relative to that information.
We will never retaliate against you for filing a complaint. Nor will we ask you to waive any legal right that you may have as a
condition of filing a complaint. You can use this form to prepare your complaint if you wish. Please submit your complaint to:
Ms. Patricia A. Wilcox, Director of Risk Management, Conifer Park, Inc.
79 Glenridge Road Glenville, NY 12302
Phone: (800)989-6446 ext. 8323
You may also file a complaint with the United State Department of Health and Human Services. To do so, contact:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: 1-800-368-1019