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<br />DRAFT <br /> <br />. <br /> <br />File a complaint with the U.S. Department of Health and Human Services at: <br />u.s. Department of Health and Human Services <br />Hubert H. Humphrey Building <br />200 Independence Avenue, S.W. <br />Washington, D.C. 20201 <br /> <br />The City will not retaliate against you for filing a complaint. <br /> <br />As a self-funded entity, your health plan and the City are one and the same. However, the <br />City is prohibited from using or disclosing any protected health information for <br />employment-related activities, if the protected heath information was received or created <br />while the City was acting as your group health plan. <br /> <br />All requests related to privacy notices or protected health information should be made in <br />writing to the City's Privacy Officer: <br />City of Paris Health Plan <br />A TTN : Gene Anderson <br />P.O. Box 9037 <br />Paris, TX 75460-9037 <br /> <br />EFFECTIVE DATE <br /> <br />This privacy notice has an effective date of April 14, 2004. <br /> <br />73 <br /> <br />Rev. 10/27/04 <br />