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Health Information Privacy (HIPAA) Complaint

  1. Are You Filing This Complaint for Someone Else?
  2. Please do not provide specific health information details in this area. A staff member will contact you for detailed information regarding your complaint.

  3. Which County of Onslow Department (s) does this complaint involve?
  4. Electronic Signature Agreement*

    By checking the "I agree" box below, you acknowledge your private health information may be shared with the covered entity for purposes of investigating this complaint.

  5. Leave This Blank: