How to file a HIPAA privacy complaint with Lower Cape Fear Hospice


There is a federal law about protecting the privacy of your health information that has been created by Congress. This privacy standard is known as the Health Insurance Portability and Accountability Act, or HIPAA. More information on HIPAA and the Privacy Rule is located on the Office of Civil Rights website,

HIPAA oversees providers like Lower Cape Fear Hospice. If you believe a person at this agency violated your privacy rights you may file a complaint with the Lower Cape Fear Hospice Privacy Officer. The Privacy Officer must investigate each complaint.

Your complaint must: (1) be in writing, either on paper or electronically; (2) name the person, program or agency that violated your privacy rights; (3) describe what happened; and (4) file the complaint 180 days from when you knew the act occurred.

I have a complaint. How do I file?

You can file a complaint with the Privacy Officer by mail, fax, or email. If you need help filing a complaint or have a question about the complaint form, please call (910) 796-7900.

Complaints must be submitted to the Lower Cape Fear Hospice. You can submit your complaint in any written format. We recommend that you use the Privacy Complaint Form or you may call at (910) 796-7900 and have the form mailed to you.

HIPAA prohibits anyone from taking retaliatory action against you for filing a complaint. You can notify the Privacy Officer immediately if you believe you or anyone else is the victim of any retaliatory action.

Complaints: How to file

To submit a complaint to this office, please choose one of the following:

Option 1: Download the Health Information Privacy Complaint Form to your own computer; save the form; and then use the Tab and Shift/Tab on your keyboard to move from field to field in the form. Then, you can either: (a) print the completed form and mail or fax it; or (b) email the form to

Option 2: You can contact the Privacy Officer at (910) 796-7900 and request a Complaint Form be mailed to you. Return the completed form to the address identified on the form by mail or fax.

Option 3: If you choose not to use the Health Information Privacy Complaint Form, please provide the information specified below and either: (a) send a letter or fax to:
Lower Cape Fear Hospice
HIPAA Privacy Officer
1414 Physicians Drive
Wilmington, NC 28401
Fax number: (910) 796-7901
Email the form to

To fully consider and investigate a complaint, the following information must be provided:

  • Your name, full address, home and work telephone numbers, email address.
  • If you are filing a complaint on someone’s behalf, then provide the name of the person on whose behalf you are filing.
  • Name, full address and phone of the person, agency or organization you believe violated your (or someone else’s) privacy rights or committed another violation of the Privacy Rule.
  • Briefly describe what happened. How, why, and when do believe your (or someone else’s) health information privacy rights were violated, or the Privacy Rule otherwise was violated?
  • Please tell us about any other relevant information. For example, have you filed your complaint anywhere else?
  • Please sign your name and date your letter.

Please keep a copy of the complaint you submit for your records.

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