NOTICE TO PATIENTS
ACCESS TO HEALTH RECORDS & CONSUMER COMPLAINT INFORMATION
In accordance with Texas Health & Safety Code 181.105, patients are entitled to instruction regarding:
Requesting medical records
Contacting the applicable licensing authority
Filing a consumer complaint
HOW TO REQUST YOUR MEDICAL RECORDS
Step 1:
Submit a written request to our office by:
Email: office@elevationsportsmed.com
Fax: (214) 233-5512
Mail: Elevation Spine and Sports Medicine
2761 E Trinity Mills Rd Suite 100
Carrollton, Texas 75006
In person during normal business hours
Step 2:
Include the following information:
Full Name
Date of Birth
Phone Number
Date of Treatment requested
Specific records requested
Signature and date
Step 3:
Provide a Cody of a valid government- issued photos ID
Step 4:
Our office will process your request in accordance with applicable Texas Law and HIPAA regulations.
Reasonable copying and mailing fees may apply as permitted by law.
For questions regarding records request, contact our office at”
Phone: (214) 233-5512
2. HOW TO CONTACT THE CHIROPRACTIC LICENSING AUTHORITY
Texas Chiropractors are regulated by the:
Texas Board of Chiropractic Examiners
Website: TBCE.com
Phone: (512) 305-6700
Mailing Address:
Texas Board of Chiropractic Examiners
333 Guadalupe Strett, Ste. 3-825
Austin, Texas 78701
You may contact the board regarding:
Licensing questions
Disciplinary matters
Professional conduct concerns
Filing complaint against a chiropractor
3. HOW TO FILE A CONSUMER COMPLAINT
Patients may file a consumer complaint regarding protected health information, privacy rights, or health care concerns under Texas Health & Safety Code 181.103.
Step 1:
Visit the Texas Attorney General Consumer Protection Website
Step 2.
Complete the online complaint form or request a paper complaint form.
Step 3.
Provide:
You contact information
Name of the provider or facility
Description of the complaint
Relevant dates and supporting documents
Step 4:
Submit the complaint through the Attorney Generals Website or by mail.
PO BOX 12548
Austin, TX 78711-2548
Attorney General Consumer Protection Division
Phone: (800) 621-0508
This Notice is provided pursuant to Texas Health & Safety Code 181.103 and 181.05