We believe that privacy is part of Walgreens commitment to you. If you have a complaint about our privacy practices or would like to request information about how your personal information has been used, please contact us at one of the links below. Or, contact us at email@example.com.
If you have a complaint about our Privacy Practices,
print out a complaint form (PDF) to mail to us, or
Walgreens Privacy Office
200 Wilmot Road, MS 9000
Deerfield, Illinois 60015
Request for Accounting of Disclosures
You have the right to know how your information has been used.
Print out a Request for Accounting of Disclosures form to mail to us.
Request to Access Form
You may request to review the personal health information held about
you in accordance with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
Print out a Request to Access Form.
Request for Alternate Means of Communication Form
You may request that your protected health information be sent to you
via alternative means or to an alternative location.
Print out a Request for Alternate Means of Communication Form to mail to us.
Request to Amend/Correct Protected Health Information
If the health information held about you is incomplete or incorrect,
you may request to amend/correct it here.
Print out a Request to Amend/Correct Protected Health Information.
Request Restrictions on Personal Health Information Use and Disclosure
You may request to restrict the use and disclosure of your protected
Print out Restrictions on Personal Health Information Use and Disclosure.
PHI Release Authorization (Personal Representative)
You may wish to have a spouse, parent, adult child, or caregiver have
access to your medical and health information on an on-going basis to
assist with your care and maintaining your information.
Print out a PHI Release Authorization (Personal Representative) form to mail to us.
PHI Release Authorization (Third Party)
You may use this Authorization form if you are authorizing the
release of medical/health information to a third party, such as a
housing authority, insurance company, or law office.
Print out a PHI Release Authorization (Third Party) form to mail to us.
Download Acrobat Reader.
Read our Notice of Privacy Practices.
Read our Online Privacy and Security Policy.