University Physicians of Brooklyn Correspondence Unit Box# 80 450 Clarkson Ave. Brooklyn, NY 11203 If you do not submit a statement of disagreement, we will include only your amendment request and this denial notice in any future disclosures of the information which you think should have been amended. We hope that you will understand the reason that we have denied the amendment you requested. However, if you believe that we have improperly handled your request, you may file a complaint with us or with the Secretary of the United States Department of Health and Human Services. To file a complaint with us, please contact the Department of Patient Relations at (718) 270-8105. No one will retaliate or take action against you for filing a complaint. Sincerely, ______________________ Department
University Physicians of Brooklyn Correspondence Unit Box# 80 450 Clarkson Ave. Brooklyn, NY 11203 If you do not submit a statement of disagreement, we will include only your amendment request and this denial notice in any future disclosures of the information which you think should have been amended. We hope that you will understand the reason that we have denied the amendment you requested. However, if you believe that we have improperly handled your request, you may file a complaint with us or with the Secretary of the United States Department of Health and Human Services. To file a complaint with us, please contact the Department of Patient Relations at (718) 270-8105. No one will retaliate or take action against you for filing a complaint. Sincerely, ______________________ Department
Patient-Amendment-Notice-of-Denial-Letter-updated-form-05-22-17.docx