Below found with:
http://www.google.com/search?hl=en&gbv=2&q=reporting+medical+data+breach
Pay attention to the last paragraph, control
number and expiration date required!
Questions About a Reporting a Breach?
Email the FTC at
Healthbreach@ftc.gov, or call us at (202) 326-2918.
Privacy Act and Paperwork Reduction Act Statements
The form requires the person reporting the breach to provide certain information, including their name, contact phone number, and email address, as well as the name of their company and company address. The FTC may use this information to contact you to obtain additional information about the breach. The FTC Act and the Health Breach Notification Rule authorize the collection of this information. Do not include in your submission any personally identifiable information involved in the breach. To learn how we handle and safeguard your personal information, please read the FTC’s
Privacy Policy and the Privacy Act
system notices, to the extent they are applicable.
Under the Paperwork Reduction Act, as amended, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number and expiration date. The OMB control number is 3084-0150 and the expiration date is 06/30/27.
Cheers,
Tom
p.s. Several years ago I had a few similar occurences with a nearby medical imaging outfit. Every time I had some imaging done there, a month or so later I would get phone calls selling
something related; for instance an MRI of my spine triggered sales pitches for back braces. I now drive a few extra miles to another facility where, coincidently, the people are also much friendlier and professional.