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SAMPLE

PATIENT'S NAME AND ADDRESS

Date

[SEND ORIGINAL AND THREE COPIES, to arrive before Feb. 17, 2000, TO:]

U.S. Department of Health and Human Services
Assistant Secretary for Planning and Evaluation
Attention: Privacy-P
Room G-322A, Hubert H. Humphrey Building
200 Independence Ave. SW
Washington, D.C. 20201

Dear Assistant Secretary:

This letter is in response to the proposed regulations on patient privacy published in the Federal Register of November 3, 1999.

I am writing as a patient. I feel that I could be harmed by disclosure of my medical records. I believe that it is my right as an American citizen to be in control of what happens to my medical records. I do not want to have them released to persons I do not know, for purposes I cannot predict, simply because the Secretary thinks that the public will somehow benefit.

The cost of medical care is already very high. I do not want to have to pay more to see the doctor so that he can hire a "privacy official" to supervise his charts, or a lawyer to figure out the rules. In fact, I cannot afford to pay any more for medical care. And I realize that if the doctor is not able to cover his costs, then services will not be available.

I do not want to receive more pieces of paper that no one can understand. I want my medical information to be kept private; I don't want a paper telling me how it is being used by the government, insurance companies, researchers, and others that I don't want to have it. I don't want my doctor to be at risk of going to jail for protecting my privacy.

If anybody and everybody approved by the federal government can rummage through my medical records, then I will simply have to keep a lot of information to myself. I ordinarily would trust my doctor to keep confidences; but if everything he writes in my record has to be released whenever the government asks for it, how can I be sure it cannot be used against me?

Sincerely, ....

CC The Honorable ___, U.S. House of Representatives, Washington, DC 20515
The Honorable ___, U.S. Senate, Washington, DC 20515
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