Reporting a Civil Liberties Violation

Civil Liberties Addresses

Mailing Address

ATTN: Privacy Compliance Office
Building 1, Level 2, Room 2437
8901 Rockville Pike
Bethesda, MD 20889-5600

E-Mail Address

dha.bethesda.ncr-medical.mbx.wrnm-hipaa-mail@health.mil
*Please be sure to encrypt your e-mail.

Necessary Information

Please include ALL of the following information in your letter. Failure to do so may result in the inability to process your complaint.

Current Contact Information:

• Name
• Address (please indicate home or work)
• Phone number(s) (please indicate cell, work or home number)
• Email address
• Preferred method of contact

Information about Your Complaint:

• Include the date and location of the alleged violation. Please state if the violation is ongoing.
• Include Information about the individual, office, or process you are complaining about.
• Please explain which civil liberty was violated and summarize how the violation took place. Please keep this section as concise as possible.
• Note if the violation was reported to any other authorities and if any action was taken.
• Include your signature and the date.