Form HPS-404 Complaint for Alleged Violation of Disclosure of Protected Health Information (Phi) - Montana

What Is Form HPS-404?

This is a legal form that was released by the Montana Department of Public Health and Human Services - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form HPS-404?
A: Form HPS-404 is a complaint form for alleging a violation of the disclosure of Protected Health Information (PHI).

Q: What is Protected Health Information (PHI)?
A: Protected Health Information (PHI) refers to any health information that can be linked to an individual, including medical records, treatment plans, and billing information.

Q: Who can use Form HPS-404?
A: Anyone in Montana who believes there has been a violation of the disclosure of PHI can use Form HPS-404 to file a complaint.

Q: How can I obtain Form HPS-404?
A: You can obtain Form HPS-404 by contacting the appropriate authority in Montana dealing with health information privacy complaints.

Q: What should I include in my complaint on Form HPS-404?
A: Include all relevant details about the alleged violation of the disclosure of PHI, including the parties involved, dates, and a description of the incident.