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HIPAA/Privacy or Ethical Questions, Concerns or Violations Form

Please submit HIPAA, privacy or ethical questions, violations or concerns that you observed someone else do, or that occurred as a result of something you did. 


You are required to share HIPAA violations that occurred, if you do not it is a Level 4 HIPAA violation. By sharing it, we are able to take necessary and legally required steps to protect our clients. Please see HIPAA Information Page for more information on the levels and reporting requirements.

We strongly encourage all staff to report ethical questions or concerns about something you observe, hear or behavior you engaged in because to ensure we as a company protect our clients and ourselves. The ethics committee will review it within 5 business days of receipt. Once a decision has been made, the CEO and COO will review it within 2 business days of receipt.

You will receive a response within 10 business days, if you share your name. If you do not, you may not hear the response.

Ethics Committee: Nora, Alexandra and Alex

All information shared here will be kept strictly confidential. The intent of requesting honest reporting is to ensure best practice and protect our clients. Your honesty and transparency is welcomed and deeply appreciated.

Ethical-HIPAA Question, Concern, Violations Report Form

Thanks for submitting!

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