XX/XX/XXXX XXXX XXXX XXXX XXXX XXXX XXXX, FL XXXX XXXX SS : XXXX XXXX HIPAA Compliance Officer XXXX XXXX XXXX XXXX XXXX XXXX XXXX XXXX. 
XXXX, Tx. XXXX XXXX. XXXX XXXX XXXX, Tx. XXXX XXXX XXXX XXXX or XXXX XXXX XXXX XXXX XXXX. 
XXXX, TX XXXX MERCHANT & PROFESSIONAL COLLECTION BUREAU , INC. 
XXXX XXXX XXXX, XXXX XXXX XXXX XXXX XXXX XXXX, TX XXXX ( XXXX ) XXXX XXXX FAX XXXX Re : XXXX XXXX XXXX XXXX, XXXX XXXX or XXXX XXXX XXXX and MERCH & PROF CB Acct # XXXX XXXX To Whom It May Concern : This letter is in reference to Account XXXX for services provided to XXXX XXXX on XX/XX/XXXX and XXXX, XXXX. 

In regard to the bill on this account in the amount of {$800.00}. This figure is a combination of two different procedures that the XXXX XXXX XXXX XXXX XXXX preformed was for on XXXX and XXXX. XXXX XXXX paid XXXX XXXX with two different checks that were both split for both days for date XXXX in the total amount of {$1100.00} and for XXXX for the amount of {$1300.00}. For a combined grand total received from XXXX for me was {$2500.00}. On XXXX I paid {$30.00}. There for total money received {$2500.00} and then subtracted from the total invoice due {$3300.00} is the remaining balance of {$800.00}. 

Please be advised that under Federal Statutes, The Fair Credit Reporting Act, ( 15 U.S.C. 1681 et seq ) and Texas s Consumer Credit Statutes, and subtitle D of the ARRA, SEC. 13401.  APPLICATION OF SECURITY PROVISIONS AND PENALTIES TO BUSINESS ASSOCIATES OF COVERED ENTITIES ; and SEC. 13407 ( 1 ) BREACH OF SECURITY. 

The term breach of Security means, with respect to unsecured PHR identifiable health information of an individual in a personal health record, acquisition of such information without the authorization of the individual. You may be held liable for the actions of MERCHANT & PROFESSIONAL COLLECTION BUREAU , INC. 

Please note that these liabilities are under the penalty rules of the Omnibus Final Rule effective XX/XX/XXXX interpreting and implementing various provisions of the Health Information Technology for Economic and Clinical Health Act of XXXX ( HITECH Act ) as issued XX/XX/XXXX. 

( a ) Duty of furnisher of information to provide accurate information. 
( 1 ) Prohibition.

( A ) Reporting information with actual knowledge of errors.

HIPAA and Texass Medical Privacy Statutes and the penalty provisions of the ARRA section D,  privacy provisions, the penalty rules of the HITECH Act as issued XX/XX/XXXX and the Omnibus Final Rule effective XX/XX/XXXX and the FACT Act final rules effective XX/XX/XXXX are in effect in this situation. 

The Privacy Rules prohibits a covered entity from using or disclosing and individuals protected health information ( PHI ) unless specifically authorized by the individual or otherwise allowed under the Privacy Rules. 

In general, PHI encompasses substantially all Individually identifiable health information that is transmitted or maintained in any medium. Individually identifiable health information includes health information that is created or received by a health care provider, health plan, employer or health care clearinghouse, and that relates to an individuals physical or mental health or condition, including information related to an individuals care or the PAYMENT for such care. 

Your furnishing of my account information to MERCHANT & PROFESSIONAL COLLECTION BUREAU , INC., is not in compliance with the HIPAA, or Texass Privacy Act, and any subsequent reporting of this account on my credit reports to XXXX, XXXX, XXXX, XXXX, XXXX, XXXX, and all others is a clear violation of Public Law 104-191 ( HIPAA ). 

I am requesting you promptly rescind all such account information furnished to MERCHANT & PROFESSIONAL COLLECTION BUREAU , INC. and require them to purge their records of all reference to this account, and that you insure that any and all reporting of this account is immediately deleted from my credit reports. 

XXXX XXXX XXXX XXXX XXXX and XXXX  and XXXX XXXX You are also advised that you may be in violation of the Notice of Proposed Procedures for Charitable Hospitals to Correct and Disclose Failures to Meet Section 501 of the Affordable Care Act. 

Please respond, in writing within 10 days acknowledging that you are processing this request. 

I am reserving the right, to take appropriate legal and civil action including reporting to any applicable regulatory authorities any lack of cooperation or compliance with this request. 

I hereby waive my right under HIPAA and any State Privacy Act for the single purpose of your transmission of this request and accompanying documentation in any required report you must make to your E & O insurance carrier. 

Sincerely, XXXX XXXX Cc : Consumer Financial Protection Bureau Cc : Attorney Generals Office Cc : XXXX XXXX XXXX Cc : Office for Civil Rights ( OCR ). 
Cc : XXXX XXXX XXXX XXXX Cc : XXXX XXXX XXXX Cc : XXXX XXXX Cc : Federal Trade Commission Cc : XXXX Cc : XXXX  Cc : XXXX