How to File a Complaint Online if you are the Client

If you wish to file a complaint against a CPM or CPM student and you were the client, you have two options:

  1. You may complete the online form below or,
  2. You may download, print, complete, and submit this pdf file.

Before completing any forms, we’d like you to understand the following information—

Your Rights—

You have the right to:

  • Receive a list of those with whom we’ve shared information.
  • Ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-­‐based fee if you ask for another one within 12 months.
  • Receive a copy of this privacy notice.
  • Request for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • File a complaint if you feel your rights are violated.
  • You may contact us and complain if you feel we have violated your rights.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

Our Responsibilities—

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice—

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, through our office, and on our web site.

Other Instructions for Notice—

This notice is effective as of 7-6-2018.

Please direct all question to NARM Information at 888-842-4784 ext. 1 or email accountability@narm.org.

We never market or sell personal information.

Submit your Complaint using this online Form—