Federal Law > Handbooks - Policies > HIPAA Policies > HIPAA - Sample Notification Letter to Patients

HIPAA - Sample Notification Letter to Patients


HIPAA - Sample Notification Letter to Patients


Dear ________________________:


I am writing to you with important information about a recent breach of your personal information from __________________________ We became aware of this breach on _______________ which occurred on or about ______________. The breach occurred as follows:


Describe event and include the following information:


1.  A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known.

2.  A description of the types of unsecured protected health information that were involved in the breach (such as whether full name, Social Security number, date of birth, home address, account number, diagnosis, disability code or other types of information were involved).

3.  Any steps the individual should take to protect themselves from potential harm resulting from the breach.

4.  A brief description of what the organization is doing to investigate the breach, to mitigate harm to individuals, and to protect against further breaches.

5.  Contact procedures for individuals to ask questions or learn additional information, which includes a toll-free telephone number, an e-mail address, Web site, or postal address.


We also advise you to immediately take the following steps:


    * Call the toll-free numbers of anyone of the three major credit bureaus (below) to place a fraud alert on your credit report.  This can help prevent an identity thief from opening additional accounts in your name.  As soon as the credit bureau confirms your fraud alert, the other two credit bureaus will automatically be notified to place alerts on your credit report, and all three reports will be sent to you free of charge.


  • Equifax: 1-800-525-6285; www.equifax.com; P.O. Box 740241, Atlanta, GA 30374-0241.
  • Experian: 1-888-EXPERIAN (397-3742); www.experian.com; P.O. Box 9532, Allen, TX 75013.
  • TransUnion: 1-800-680-7289; www.transunion.com; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790.


We take very seriously our role of safeguarding your personal information and using it in an appropriate manner.  __________________ apologizes for the stress and worry this situation has caused you and is doing everything it can to rectify the situation.










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