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Letter To Hospital When Challenging HIPPA

HIPPA Medical to Hospital(2)

Use this letter for the hospital to inform them they have violated your rights by HIPAA by informing debt collectors your private medical information. In turn, they reported this to the credit reporting agencies.

Date you will send this letter*
MM slash DD slash YYYY
Your Name*
First Middle Last Suffix
Your Address*
Street Address Address Line 2 City State ZIP Code
Name of Hospital*

Put the name of the hospital here not collection agency but the hospital
Address of Hospital*
Street Address Address Line 2 City State ZIP Code
Social Security Number*
Account number*
Amount you owe*

Put the amount your bill is for or the amount on your credit report.
Name of Collection Agency*
Signature
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Name
This field is for validation purposes and should be left unchanged.