Resources for Privacy Practices
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 firstname.lastname@example.org.
Online or PDF Complaint Form
If you have a complaint about our Privacy Practices, please use the online complaint form or print out a complaint form (PDF) to mail to us, or contact the Privacy Office directly using the information below:
Walgreens Privacy Office
200 Wilmot Road, MS 9000
Deerfield, Illinois 60015
PDF Request Forms
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 health information.
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.