Purpose and VisionNewsEventsAwardsContact Us Website Help FormWebsite Feedback FormRequest for Billing Information and AssistanceHealth Information Privacy ComplaintCurrently selected Sidebar Content Dedicated Community LeadershipWe are accountable to our board of community leaders who dedicate their time, expertise, and energy to improving the health of patients, members, and our communities. Meet these remarkable leaders.Learn More.Legacy of CaringWe are committed to caring for our community -- and have been for more than 100 years. Learn more about Presbyterian’s first one hundred years of caring for the people of New Mexico, and where we are headed today.Learn More.Together for HealthPresbyterian Healthcare Services envisions a healthy New Mexico. Learn more about the priority health issues facing each of our communities identified in our most recent Community Health Assessment.Learn More. Home | About Presbyterian | Contact Us | Health Information Privacy Complaint Health Information Privacy Complaint Page Content If you believe your health information privacy rights or that of someone else have been violated, please fill out this form. The form will be submitted to the Presbyterian Healthcare Services Privacy Officer. If you have any questions, please call 505-923-6445 * = indicates required fields Contact Information for Person Reporting the Complaint: First & Last Name* Address* City* State* Select state Zip* Phone Number* Email* Whose health information privacy rights do you believe were violated:* Self Other If you believe your own privacy rights were violated, please provide your: If you believe someone else’s privacy rights were violated, please provide the following: First and Last Name* Date of Birth* mm dd yyyy Medical Record Number Describe What Happened: 1) Who (or what area of Presbyterian) do you believe violated your (or someone else’s) health information privacy rights? Please list all persons or areas involved:* 2) Please list all dates and approximate times you believe the violation occurred: * 3) Describe briefly what occurred and how and why do you believe your (or someone else’s) health information privacy rights were violated? Please be as specific as possible: * The control cannot be rendered without valid Public and Private keys.