When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities
to help you.
Get an electronic or paper copy of your medical record.
- You can ask to see or get an electronic or paper copy of your
medical record and other health information we have about you. Ask
us how to do this.
- We will provide a copy or a summary of
your health information, usually within 15 days of your request --
as required by Texas Law. We may charge a reasonable, cost-based
Ask us to correct your medical record.
- You can ask us to correct health information about you that
you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in
writing within 60 days.
Request confidential communications.
- You can ask us to contact you in a specific way (for example,
home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share.
- You can ask us not to use or share certain health information
for treatment, payment, or our operations. We are not required to
agree to your request, and we may say “no” if it would affect your
- If you pay for a service or health care item
out-of-pocket in full, you can ask us not to share that information
for the purpose of payment or our operations with your health
insurer. We will say “yes” unless a law requires us to share that
Get a list of those with whom we’ve shared information.
- You can ask for a list (accounting) of the times we’ve shared
your health information for six years prior to the date you ask, who
we shared it with and why.
- We will include all the
disclosures except for those about treatment, payment and health
care operations, as well as certain other disclosures (such as any
you asked us to make). We’ll provide one accounting a year for free
but we may charge a reasonable, cost-based fee if you ask for
another one within 12 months.
Get a copy of this privacy notice.
You can ask for a paper copy of this notice at any time, even if you
have agreed to receive the notice electronically. We will provide you
with a paper copy promptly.
Choose someone to act for you.
- If you have given someone medical power of attorney or if
someone is your legal guardian, that person can exercise your rights
and make choices about your health information.
- We will
make sure the person has this authority and can act for you before
we take any action.
File a complaint if you feel your rights are violated.
- You can complain if you feel we have violated your rights by
sending a letter to the Tarrant County Compliance Officer, 1101 S.
Main St., Fort Worth, Texas 76104, calling 817-321-5314, or email to
- You can file a complaint with the U.S. Department of Health and
Human Services Office for Civil Rights by sending a letter to 200
Independence Avenue, S.W., Washington, D.C. 20201, calling
1-877-696-6775, or visiting
- You can file a complaint to the Texas Regional Office of the
U.S. Department of Health and Human Services Office for Civil Rights
by sending a letter to Region VI - Dallas, Ralph Rouse,
Regional Manager, Office for Civil Rights, U.S. Department of Health
and Human Services, 1301 Young Street, Suite 1169, Dallas, TX 75202,
or by calling 214-767-4056.
- You can file a complaint with
the Texas Attorney General’s Office by mail at Post Office Box
12548, Austin, Texas 78711, or by calling 1-888-963-7111. You may
also file a complaint online by visiting
- We will not retaliate against you for filing a complaint.
For more information see:
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply
to all information we have about you. The new notice will be available
upon request, in our office, and on our web site.