How to Write a HIPAA Violation Letter

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HIPAA Violation Letter Template

Healthcare data breaches are not uncommon. There are an average of 59 data breaches involving individuals' personal health information occurring at medical facilities across the US each month.

Having your personal information stolen due to a HIPAA violation can result in costly consequences, including damage to your credit score resulting from the unauthorized use of your personally identifiable information that is often contained in healthcare reports. If you have been the victim of a HIPAA violation, you should report the violation to the federal Office for Civil Rights Headquarters.

Below is a that you can use to submit your complaint. We’ll also cover how DoNotPay can help you clean inaccurate information from your credit report if someone has used your identity.

Filing a HIPAA Violation Complaint

In order to to the Office for Civil Rights (OCR) Headquarters, you must provide information such as:

  • Your identifying information
  • Details of the complaint, including the facility where the violation occurred, the date of the violation, and how your HIPAA rights were violated.
  • Any additional information that could help the OCR to review and investigate your complaint.

The complaint must be filed with the OCR within 180 days of when you discovered the violation. Complaints can be filed in these four ways:

  1. Through the OCR's online complaint portal.
  2. By faxing the information to (202) 619-3818.
  3. By emailing the complaint to -- be aware that sending personally identifiable information through email creates a risk of that information being intercepted by unauthorized third parties.
  4. By mailing the complaint and consent form to: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Ave. S.W., Room 509 F HHH Bldg., Washington, D.C. 20201.

It should be noted that the consent form must be included with your complaint in order to authorize OCR personnel to investigate the complaint. Read on for a .

HIPAA Violation Letter Template


Full Name


Email Address, if Available

Dear Office of Civil Rights,

I am writing to report a Health Information Privacy Complaint against [Name of the facility] .This facility is located at [address and telephone number of the facility where the violation occurred].

The contact information for [facility name] is: [facility's mailing address, name of facility contact, phone number]. The case number is [insert case number, if applicable].

Explain the violation to the best of your ability, including how the release of your personally identifiable information was disclosed. The HIPAA privacy rule covers unauthorized disclosures relating to:

  • The individual's past, present, or future physical or mental health condition.
  • Provision of health care to the individual.
  • Past, present, or future payment of health care provided to the individual.

Be specific as possible when describing the situation that led to the HIPAA violation.



[Full name]

[Preferred method of contact]

What Can Happen if Your Health Data Is Breached?

Learn more about data breaches in the table below.

Data breaches involving health care information can place your personal information at risk.

The types of information healthcare records can include are:

  • Your legal name
  • Your address
  • Contact phone numbers and emails
  • Your Social Security number
  • Prescription information
  • Confidential healthcare records
This can result in damage to your credit score, which can cause difficulties for you if you are attempting to obtain a loan, buy a house, or even simply enter a new phone contract.

DoNotPay can help you get these unauthorized purchases and accounts removed from your credit report so that your credit score can be increased.

How DoNotPay Can Help You Clean Inaccurate Information from Your Credit Report

DoNotPay's Clean Credit Report can provide assistance in several ways:

  • Filing a goodwill removal request letter with creditors who you've paid off in order to remove old late payments from your report.
  • Sending a credit report dispute letter to the credit bureaus in order to dispute accounts appearing on your report that you did not open.
  • Submitting a debt validation request to the creditor if you believe the debt does not belong to you.
  • Mailing a pay-to-delete negotiation letter, which is a settlement offer for the creditor whereby you pay the debt and they remove negative information from your report.

Start Cleaning Your Credit in Three Easy Steps

In order to start cleaning your credit report, follow these three easy steps:

  1. Search Clean Credit Report on DoNotPay.

  2. Prepare a recent copy of your credit report that you can use as reference.

  3. Let us guide you through the 4 potential options:
  1. If you've already paid off your debt, we'll help you file a Goodwill Removal Request to get it removed.

  2. If you notice any errors in your report (we have a list of common errors you can use!), we'll help you file a credit dispute to the creditor or major credit bureaus.

  3. If there are no errors, we'll check if you're still eligible to file a debt validation request. If they can't validate your debt, they're required to remove it from your report and they can't collect it!

  4. Lastly, if none of the above options work, we'll help you file a pay-to-delete negotiation letter. You can customize the amount you are willing to pay in exchange for getting the item removed.

We will send the appropriate letters on your behalf and you can expect to hear back directly from the credit bureau or creditor within a few weeks. Be sure to take a look at our other credit products, including Credit Limit Increase, Get My Credit Report, Keep Unused Cards Active, and more.

What Else Can DoNotPay Do?

In addition to , DoNotPay can assist you in completing other common, time-consuming tasks with less effort. Some of these tasks include appealing a financial aid decision, paying your bills on time, and canceling subscriptions. To learn more about all the ways DoNotPay can help you save time and effort, sign in or sign up today.

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