HIPAA Complaint and Suggestion Form

If you have complaints or suggestions about UTHSC policies and procedures covering HIPAA (including ARRA provisions) or compliance with the policies and procedures or the requirements, complete this Complaint and Suggestion Form.

Your name and a description of the complaint or suggestions are the only required fields below. However, we may not be able to fully address your complaint or suggestion without a valid way to contact you with questions. Please note that any contact or communication will be kept strictly confidential.

Name:

Mailing Address:

City:

State:

Zip:

Phone:

E-mail:

Description of Complaint or Suggestion:

Privacy Officer

Carolyn Moffitt
920 Madison Ave.
Suite 807
Memphis, TN 38163
Phone: (901) 448-1672
Email: cmoffitt@uthsc.edu

IT Security Officer

877 Madison
Memphis, TN 38163
Phone: (901) 448-1880
Email: itsecurity@uthsc.edu

Complaints or Suggestions?

If you have any complaints or suggestions about UTHSC policies and procedures covering HIPAA (including ARRA provisions) or compliance with the policies and procedures or the requirements, complete our Complaint and Suggestion Form.